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Tradition

Religious Beliefs and Healthcare Decisions By

he Hindu tradition is one of the oldest living reli- Tgious traditions of the world. Identifiably Hindu practices and objects have been traced to what used to be called the Indus Valley culture but is now referred to increasingly as Harappan culture, after its best-known archeological site. This culture was con- temporaneous with the earliest indications of civiliza- Contents tion in Egypt, Mesopotamia, and . The Individual and the 5 The relationship of this culture to the , the Patient-Caregiver Relationship foundational texts of , remains obscure. The earliest of these Vedic texts, called the RgVeda. , had Family, Sexuality, and Procreation 6 been compiled by 1200 B.C.E., according to most Genetics 8 scholars. Its appearance commences the age of Vedic Organ and Tissue Transplantation 9 culture, which lasted until around the fourth century B.C.E. By the sixth century B.C.E., religious life in 10 was already in ferment as a result of the gradual Medical Experimentation 11 dissolution of the Vedic sacrificial , and out and Research of this ferment emerged the other two great religious and Dying 11 traditions of ancient India: and . The interaction of the Vedic tradition with these tradi- Special Concerns 13 tions gave rise to what is usually referred to as classi- cal Hinduism. The classical Hindu tradition, while it underwent numerous transformations and remained in continu- ous interaction with both , was the main of the Indian sub-continent until the arrival of in a decisive way around 1200 C.E. The succeeding six hundred years saw the progres- Part of the “Religious Traditions and Healthcare Decisions” handbook series published by the Park Ridge Center Arvind Sharma, Ph.D., is Birks of in for the Study of Health, , and the Faculty of at McGill University, Montreal, .

THE PARK RIDGE CENTER sive establishment of Muslim rule over virtually engaging in a dialogue with him or her on this the whole of the Indian sub-continent and is point. therefore referred to as the Muslim period of Most believe in (punar- Indian history. This period is characterized by janma). From this follows a corollary various modes of interaction between Hinduism belief in multiple lifetimes of in the and Islam. past and the (sams ˙ ara ¯ ), lifetimes in which By 1800 the British were well on their way to the quality of one’s present life is determined by achieving political control of the subcontinent. the quality of one’s past life (especially moral When they relinquished control in 1947, India life) as led in previous lifetimes (). It is and emerged as independent states. For thus possible to improve the quality of one’s life the most part, Pakistan was carved out of those over several lives and attain a better , but parts of India that had Muslim majorities. the ultimate Hindu religious aims at tran- Hinduism continues as the religion scending the process of the cycle of rebirths of India, over 80% of whose citizens count as itself. The successful attainment of this goal is Hindus. There are over a million Hindus in the called mok.sa or mukti (liberation). U.S.A., primarily as a result of Indian immigra- Several ways of attaining mok.sa are identified tion. The Indian diaspora, as the spread of peo- within the tradition. These methods are collec- ple of Indian origin through different parts of tively called . The word is formed from a the world is called, includes about 20 million root which means “to join”; hence any system of Hindus. belief and practice which unites the seeker with the ultimate () can be called yoga. Such a union, when successfully effected, BELIEFS RELATING TO HEALTH CARE involves liberation from sams ˙ ara ¯ and thus leads to mok.sa. An important point to consider at the very out- The importance of health in the context of , before specific beliefs of Hinduism which the practice of yoga is widely recognized, and a may relate to health care are taken into account, famous maxim attributed to one of classical is the of Hinduism itself as a belief sys- India’s most famous poets states that the body tem. Hinduism is a broad-based and doctrinally should be viewed as the primary instrument for tolerant religion with hardly any single and attaining mok.sa. This maxim is put into practice exclusive test of , with the result that in Hatha. Yoga, which takes the physical body as diverse and even contradictory beliefs can be the starting point of yoga (as distinguished from found co-existing within it. This diversity also the more usual practice of using the as the encompasses the reality that “” and point of such departure, as in R¯aja Yoga). In the the “religion of women folk” flourish freely West the term yoga has been almost exclusively within Hinduism, without the doctrinal con- identified with the physical form of yoga, straints that these expressions of religion might because of its popular appeal as a way of secur- face in the Abrahamic , which attempt ing and maintaining physical and even mental to “rationalize”1 these dimensions of religion. By health. The Hindu religious tradition, however, the same token, one must not presume to know associates the word yoga with the control of what the beliefs and practices of a patient might the body as well as the mind, and R¯aja Yoga be from the mere fact of his or her a arguably associates it more with the mind than Hindu. Because Hinduism lacks a standard defi- the body. nition, and practice tends to take precedence Some of these yogic techniques go back to over theory, it is best to elicit the specific the and may even have been part “Hindu” religious life-pattern of the patient by of Harappan culture. In due course, however, a

2 THE HINDU TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS distinct branch of devoted to the cul- varies from individual to individual and is tivation of health and the treatment of diseases affected by and , Hindu medicine emerged. It was even accorded the status of a has always been patient-oriented, with a strong subsidiary Veda and is called A¯yur-Veda or the in , in which even the popular clas- “science” of longevity. The main textbooks of sical scripture of Hinduism, the Bhagavadgit¯¯ a, such medical lore in India are the Compendia evinces some interest. attributed to Caraka (c. 1st and 2nd century Some forms of Hinduism take the concept of C.E.) and Su´sruta (c. 4th century C.E.), the for- pollution very seriously. Although this concern focusing more on surgery and the latter on could easily represent a survival of early reli- physiology. Late Compendia, such as the gious beliefs, scholars have proposed that the As..t¯angahrdaya. of V¯agbha.ta (c. 8th century) concept may also imply an of the emphasize diagnosis and the use of pulse to this germ theory of disease and the need for quaran- end. M¯adhava (c.1370), an authority on diagno- tine in an age given to pandemics, although the sis, lived during the period of the Vijayanagar point has also been vigorously disputed.3 empire (14th-17th century). The important point to note here is that, Central to Hindu views of health and morbid- because of such notions, the Hindu has a ity is the concept of humors or dosa. . These are greater aversion in to contact with three, as with the Greeks: v¯ata (wind); pitta blood, urine, dead bodies, fecal , and the (bile); and kapha (phlegm). Physical well-being like than the average Westerner. Similarly, since consists in maintaining a balance between the by its nature Hinduism allows for the persist- three. ence of beliefs, the idea that illnesses may be This of the three humors is a part of caused by extra-medical or even magical sources tacit knowledge among Hindus and therefore such as the eye, , etc. is often found bears elaboration, as a Hindu patient may use among Hindus, along with a comparable confi- such phrases as “my pitta is acting up.” The fol- dence in , , or divine or saintly lowing table may be helpful in this respect: intervention to cure ailments that far exceeds their clinically demonstrable results. Age of Associated Humor Dominance Personality Type V¯ata Advanced age Artistic type OVERVIEW OF RELIGIOUS Pitta Middle age Executive type AND ETHICS Kapha Childhood Mental type The fabric of religious morality and ethics in The three dosas. are also linked to an even Hinduism exhibits a particularistic as well as a more popular and pervasive trichotomy of the universalistic strand. Hindu social thought three gunas. or qualities, called (lightness, emphasizes the first, Hindu the lat- sublimity), (), and (darkness, ter: Hinduism recognizes both. inertia). In this scheme, pitta is related to sattva; Hindu social thought in general is heavily v¯ata to rajas; and kapha to tamas. indebted to four overarching concepts: the ideas Equally significant is a less pedantic and more of the four classes (c¯aturvarnya. ), the four stages popular classification of , diseases, and of life (catura´ ¯srama), the four ends of drugs into hot (us.na. ) and cold (´¯ ). “Thus hot endeavor (purus¯.-catus.taya. ), and the four diseases need cold foods and cold drugs and ages (caturyuga).4 According to the first, society cold diseases the reverse.”2 is vocationally divided into four classes, consist- As the proportion in which the three ele- ing of (1) , (2) warriors, (3) agriculturists ments or humors are present in a bio-system and traders, and (4) laborers (br¯ahmana. ,

THE PARK RIDGE CENTER 3 ksatriya. , vaisya´ , and s´udra¯ respectively). Accord- use of as inconsistent with their . ing to the second, each individual is ideally - Women often subordinate their own concerns to alized as passing through the stages of life. that of the family in the pursuit of their dharma. These are specified as those of (1) student, (2) Since this attitude may have a direct bearing on , (3) , and (4) renunciant a woman’s physical and mental health, the prac- (brahmacari ¯ ¯, gr.hastha, , ¯ sanny¯¯). titioner needs to be aware of this dimension of According to the third, such an individual, living Hindu ethical practice. in society, may pursue four valid goals of life. Along with the situated character of a human These involve the pursuit of (1) , being, however, there is an equally clear recog- (2) wealth and power, (3) sensual and aesthetic nition of the ethics and morality of a human , and (4) liberation (referred to as - being qua human being. Thus discussions of ma, artha, k¯ama, and mok.sa). All these are to specific ethics conclude with considerations of be done or attended to while living in the pres- universal ethics, which is specially emphasized ent age, called the Kaliyuga, which is the last of in a spiritual context. A famous text on yoga, the the four ages that recur periodically at astro- Yoga ¯ of Pata˜njali, lays down the following nomical intervals (the previous three being ten moral rules as the starting point of his Yogic kr.ta, tret¯a, and dvapara ¯ ). system: non-violence, truthfulness, non-stealing, The point of these four quadripartite classifi- , non-possession, purity, , cations is that in one respect ethics is specific to austerity, study, and faith in . These have one’s vocation, age, , teleological disposi- been compared to the . tion, and cosmo-temporal placement. Thus the As for medical ethics per se, the Hindu equiv- conduct appropriate to a (who may not alent of the Hippocratic oath runs as follows: retaliate if attacked) is not appropriate for a war- rior (who may). Similarly, what is not appropri- ate conduct for a student (having sex) is appro- If you want success in your practice, wealth and priate, even enjoined, for the householder, and fame, and after your death, you must pray so on. Hinduism pays more attention to these every day on rising and going to bed for the wel- specific duties and responsibilities than do many fare of all , especially of cows and brah- religious traditions. The minutiae of Talmudic mans, and you must strive with all your for and Islamic provide a useful parallel here. the health of the sick. You must not betray your The term dharma is an important one in this patients, even at the cost of your own life . . . You context, especially when used to designate one’s must not get drunk, or commit evil, or have evil duties as flowing from one’s vocation, age brack- companions . . . You must be pleasant of speech . . . et, gender, etc. Thus members of the priestly and thoughtful, always striving to improve your class may forgo certain treatments involving the knowledge.5

4 THE HINDU TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS THE INDIVIDUAL AND THE PATIENT-CAREGIVER RELATIONSHIP

t was noted earlier that Hindu medical thought -telling and confidentiality Iis as much patient oriented as disease oriented. The following excerpts from the Caraka This orientation is in keeping with the general Sam˙ hita ¯ (III.8.7), which are also part of the tendency within Hinduism towards recognizing Hindu equivalent to the Hippocratic oath, bear the specificity of a situation. In this , the directly on this point: specific and hence individualistic nature of Hindu thought inclines it toward a recognition of what are now called individual rights. More- You must not betray your patients, even at the cost over, although the reincarnatory process takes of your life. . . . all forms of life in its maw, Hindu thought emphasizes human birth as especially precious, When you go to the home of a patient you should because it provides the cusp for moving towards direct your words, mind, intellect and mok.sa. Existence in sub-human forms of life is nowhere but to your patient and his treatment . . . too burdensome to permit this movement, while Nothing that happens in the house of the sick existence in supra-human forms is too pleasant man must be told outside, nor must the patient’s to provide the necessary motivation. condition be told to anyone who might do harm It might be useful to clarify an important by that knowledge to the patient or to another. philosophical point at this stage. The exhorta- tion to give up one’s ego in the search for the possesses a confusing moral Proxy decision-making symmetry with lack of -assertion. This confu- Because of the prevalence of the joint family sion results from not distinguishing between the system, the drawing up of a will as such is not a empirical ego and the metaphysical ego, which significant element in , but expres- in Hinduism is posited as a corollary to our indi- sions concerning posthumous arrangements for vidual existence. All moral assumes the oneself and their proper respect are attested to. existence of a well-defined empirical ego. The Hence proxy decision-making is eminently lack of development of an empirical ego should acceptable.6 not be confused with the dissolution of the metaphysical ego. Women and clinical care The practitioner needs to know that Hindu women may be less than forthcoming regarding CLINICAL ISSUES about female biological and sexual , over and above the usual reluctance Self-determination and informed which characterizes such disclosures. This reti- Self-determination involves an unambiguous cence is especially likely if the practitioner is a relation between the actor and his or her member of the opposite sex, since gender segre- actions. When such a relationship is ambiguous gation is an important feature of traditional on account of age (childhood, senility) or tem- Hindu culture. Most Hindu women of course porarily clouded by extreme physical or mental adjust to the modern situation with relative stress, or disrupted by accidental happenings, ease, but the fact is worth mentioning. Part of then the degree of self-determination required stri¯-dharma or conduct appropriate for women for informed consent cannot be assumed to be involves the observance of or fasts, a present. practice which possesses an obvious relevance in the context of health care.7

THE PARK RIDGE CENTER 5 FAMILY, SEXUALITY, AND PROCREATION

he Hindu word for is . Treat your like a god. Treat your father like TThe word etymologically means a life- a god. Treat your teacher like a god. Treat your guest led for the sake of realizing the ultimate reality like a god.9 (brahman). This semantic identification of such a life-style with celibacy serves well to indicate the high spiritual value attached to celibacy in Hinduism accepts the insight that it is the Hindu culture, reinforced in recent by the fundamental telos of life to perpetuate itself. examples of such religious leaders as R¯amakr..sn.a Since this is best ensured by as Paramaham˙ sa (1836-1886) and Mahatma practiced within a , Hinduism considers (1869-1948). this expression of sexuality as normative and is Hinduism, however, also emphasizes family averse to other forms of sexuality. It is not, how- life, family values, and children,8 even as it ever, overly judgmental in this regard.10 upholds renunciant ideals. It has been plausibly It is worth noting that the Hindu family has suggested that the Hindu scheme of varn.a´¯ srama not become nuclear in the Western sense, dharma—of the doctrine, alluded to earlier, of although the is gradually changing the four varn. as and the four as¯ ´—was its in that direction. Traditional Hindu families own version of a middle path between monastic were and often are extended families where and family life. While sex before or outside mar- grandparents, uncles and aunts, and others may riage is frowned upon, sex within marriage is also constitute part of the household. approved and progeny encouraged. The ideal of monogamy is advocated through the figure of Ra¯ma as a role-model. Ra¯ma, although a king, CLINICAL ISSUES remained loyal to his Si¯ta¯, despite long periods of separation from her. Contraception Family is an important focus of Hindu value Hinduism does not take a doctrinaire stance formation. Its two best-known epics, the against contraception. Indeed, scriptural evi- Ra¯ma¯yan. a and the Maha¯bha¯rata, serve as an dence seems to support a positive attitude example and a warning respectively in the context towards it;11 to the extent, however, that contra- of family values. The family is also recognized as ception may encourage extramarital sex, and an important locus of value formation. The fol- especially premarital sex, Hindus tend to be wary lowing valedictory address found in the Taittiri¯ya of it, as such behavior undermines family values. Upanis.ad (1.11) is instructive in this respect: Hinduism in general favors a case-study as opposed to an a priori approach to ethics. Thus the overall context in which contraception is Speak the truth. Be righteous. Do not neglect encouraged becomes important. Considering the scriptural study. After having made a valuable context minimizes polarization in such decision- to the teacher, do not sever the family line. making and encourages gradation of options. Thus the interests of the individual may be sub- Do not neglect truth. Do not neglect duty. Do not ordinated to those of the family; of the family to neglect health. Do not neglect wealth. Do not neg- those of the county; of the county to those of lect study and exposition. No do not neglect the the region; of the region to those of the nation; rites to the elders and the ancestors. and of the nation12 to those of the larger world. Therefore if overpopulation leads to overcon- sumption, which in turn poses a threat to the

6 THE HINDU TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS ecosphere, then the case for contraception is risk that, if the child were born, it would suffer strengthened. such physical or mental abnormalities as to be seriously handicapped.” Two appendices state that Sterilization when a pregnancy is caused by rape or the failure Voluntary sterilization is permissible, but invol- of a device, “grave injury” will be untary or forced sterilization is strongly assumed.14 opposed. Vigorous promotion of enforced sterili- zation in India by Mrs. Gandhi, the prime min- ister, during of 1976 is widely It must be noted that, at the same time, believed to have been responsible for her subse- “many Hindus are disturbed by the use of elec- quent electoral defeat tive as birth control.”15 The negative side of the availability of abor- New reproductive technologies tion is represented by the phenomenon of gen- The Hindu imagination has little difficulty in der bias: “Between 1978 [and] 1983, 78,000 accepting new reproductive technologies. female fetuses were aborted.”16 It is worth Figures in its sacred literature have been known noting, however, that Hindu religious leaders to metamorphose themselves into various ani- “consider the use of abortion for sex selection, forms to enjoy the joys of sex. Hinduism usually used to secure male children, to be retains a memory of the practice of niyoga (the immoral. It is considered infanticide,”17 and has levirate), which may be considered, at some been strongly denounced. stretch, as an ancient form of artificial insemina- The practitioner may to note the over- tion. Accounts in Hindu lore of babies born whelming tendency towards male fetal sex selec- from jars anticipate modern procedures. Hindu tion in India, which has been discussed at practice may prove more resistant to new tech- length in both medical and popular literature. nologies, but given the value attached to proge- Thus questions of abortion may possess not ny it might be possible to instill the acceptability merely a medical but sometimes a cultural of such procedures. dimension as well.

Abortion Care of severely handicapped newborns The Hindu attitude to abortion is a study in The Hindu attitude to severely handicapped contrast between theory and practice. Abortion newborns reflects the interface of several doc- is frowned upon in the Hindu scriptural texts.13 trines, such as that of , or ahim˙sa¯, Yet it is available virtually on demand in pres- and those of karma and dharma. Since the alter- ent-day India. The pregnancy termination act of native to caring for severely handicapped new- 1971 does provide for restrictions, but they can borns is doing away with them and this course of be interpreted very liberally. action goes against the doctrine of nonviolence, it is not available as an option. The handicapped could be viewed as working out their bad karma In the late 1980s 3.9 million induced through their present condition. This view could, were reported annually in India. Abortion has however, easily lead one into blaming their bad been legal in India since 1971, when the Medical karma for their condition.18 If, however, we ask, Termination of Pregnancy Act was passed. It “What is our dharma (duty), given that the other allows for abortions when “the continuance of the person’s karma brought the person to his or her pregnancy would involve a risk to the life of the current state?” the question shifts the focus and pregnant woman or of grave injury to her physical is widely acknowledged to reflect the proper eth- or mental health” or when “there is substantial ical response.

THE PARK RIDGE CENTER 7 GENETICS

he central significance accorded the doctrine CLINICAL ISSUES Tof reincarnation in Hinduism is crucial for assessing its position on genetics. Genetics Sex selection and selective abortion essentially looks upon life as involving biological Prenatal sex selection has become a major issue continuity; Hinduism looks upon life as involv- in India: the ratio of women to men fell from ing spiritual continuity, when “spiritual” is used 935:1000 in 1981 to 927:1000 in 1991.19 as an adjectival form of the word or soul. Researchers are divided into two camps as to the Hinduism possesses a concept, sam˙ska¯ras, which cause. One group blames cultural factors such as corresponds in a spiritual sense to that of genes, preference for male children, need for dowry, but sam˙ska¯ras are not biological but psychic in of widowhood, and so on.20 The other group nature. And since the nature of reincarnation is blames socio-economic factors,21 such as reliance determined by one’s karma, it might be permis- on sons alone for old-age support in the absence sible to argue that in Hinduism the genetic of a social security net, a view of sons as eco- endowment one obtains could be viewed as the nomic assets, and the like. Asian countries outcome of one’s karma. where both sons and daughters have begun Several conclusions about genetics from the jointly supporting older parents have overcome perspective of Hinduism may be drawn from gender imbalance. Education and economic these observations. Hinduism would strongly opportunity seem to hold the key.22 resist any form of genetic as reduc- tive, as an attempt to explain the “higher” in Gene therapy and genetic screening terms of the “lower.” At most, it would admit These practices belong to the realm of preven- genes as only one factor among a complex of tive medicine and would be acceptable. factors, some of which are decidedly spiritual, that outcomes in life. At the same time, Cloning Hinduism’s emphasis on conscious decision- The Abrahamic traditions tend to resist cloning; making (an implication of its doctrine of the the Hindu approach is more accommodating. four ends of life) and its disposition favoring Hindu religious imagination is familiar with ana- experimentation in general would encourage logues to cloning in its mythic lore.23 It would, genetic engineering and experimentation. however, be opposed on moral principle to egois- However, Hinduism’s insistence that the moral tic or spare-part cloning of other creatures. compass never be abandoned implies that prop- Cloning creates interesting issues for the doc- er ethical protocols must always be observed in trine of karma and the concept of a “soul,” but such endeavors. Chief among ethical considera- although these ideas may complicate the discus- tions would be the question: To what extent do sion they do not negate the basic position. any experiments in genetics involve wanton destruction of human life, and to what extent do they involve cruelty to other forms of life?

8 THE HINDU TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS ORGAN AND TISSUE TRANSPLANTATION

ne of the favorite of Hindu theologi- egalitarian protocols, since life, as such, is of Ocal folklore—of how the god Gan. es´a came equal value for all.25 to possess an elephantine head—has to do with Hinduism would favor procedures that an organ transplant. Thus at one level there lengthen life span on two counts: its general would be minimal subliminal resistance to the preference for longevity,26 and a general sense procedure. that, the longer a person lives, the greater the At another level, however, problems could likelihood that the person will become spiritual- arise. As the transplant usually involves organs ly disposed.27 or tissue recovered from a recently deceased The karmic implications of a transplant are person, considerations of purity and prac- significant, especially in of stories that the tice could come in the way of organ removal. transplantees develop a craving for the food Certain Hindu practices, such as those of preference or other aspects of the life-style of s´ r a¯ddha (a commemoration of the dead), involve the deceased owner of the transplanted organ. a concept of a person migrating to another world, a mental picture best imagined with all For donors limbs intact. However, although the practice The donation is made either by the person or by continues, this vision has paled and has been the family. There is real tension here between a replaced by a more spiritual concept.24 sense of possession and . There are precedents for one’s body parts while in a state of moral , as in the story of King CLINICAL ISSUES S´ivi, who willingly chopped off his limbs and gave them to a falcon as ransom for the life of a For recipients dove.28 In the absence of such compelling cir- One issue in transplantation would be that of cumstances, the permission of the donor may be egalitarian transplant allocation procedures. secured in advance, as well as permission from Every society, left to itself, tends to deviate in the family members, for family members could the direction of its structural orientation, claim a legal right over the body of the depart- whether based on class, , wealth and so on. ed. Given Hindu social structures, it is best to Resource allocation could then become biased obtain permission in advance when the donor in these directions as well. Hence the need for may be able to take care of these objections.

THE PARK RIDGE CENTER 9 MENTAL HEALTH

ental health in this section will be under- CLINICAL ISSUES Mstood in a broad sense. With this under- standing in mind, the fields of transpersonal and behavior modification , , parapsychol- If the goal of psychotherapy is behavior modifi- ogy and object relations can be examined in the cation, then such a change can also result from a context of Hinduism. “spiritual” or existential insight. This recognition extends conventional psychology beyond west- seems to be a basic contribution that Hinduism ern concepts of the mind. Here the most signifi- can make to mental health care, and it may be cant Hindu contribution comes from the realm immediately illustrated with a Buddhist example. of , in which the best documented When Kisa¯ Gotami¯33 lost her child, in the famous effects have come from transcendental medita- parable of the mustard seed, she was so dis- tion (TM).29 Humanistic psychology extends psy- traught with that “people said she had gone chology beyond the limited western concept of mad.” It was through the existential realization the self-centered self into one more fully human that death is an inevitable condition of human and incorporates psychological insights from existence that she regained her mental health. Hinduism. An attempt in this direction is This technique is often employed by Hindu already evident in the work of , as when they tell a person who has just and .30 is more been involved in an accident: “Adversity some- concerned with the realm of extrasensory per- times saves us from calamity.” ception, and Hindu exploration of the and extra-cerebral memory is relevant here.31 Electroshock and The object relations approach focuses more on Apart from the fact that these techniques might mental health in the context of interpersonal cause to the patient, using only the mind to relationships, and here the role of the in deal with and cure the mind would be deemed the Hindu tradition becomes important.32 somewhat limiting in Hinduism. The shock of The basic Hindu position, namely, that the a superior insight will be preferred to electric self is more than merely a complex of body- shock and spiritual stimulation will be preferred mind, is crucial to the discussion of mental to other forms. health in Hinduism. This understanding enables One must also differentiate here between its position to be distinguished from the yogic techniques, which carry one over one’s Buddhist, which views the person as a purely traumas to the other shore, and modern proce- psycho-physical organism, and also underscores dures that involve wading through the “muck,” the fact that, in order to know the mind, one as it were, to reach the other shore. must know more than the mind. Thus mental health becomes part of spiritual health. Psychopharmacology Although Hinduism at its most receptive admits even of chemical means of attaining mok.sa,34 mainline Hinduism views pharmacological manipulation with an aversion bordering on .35

10 THE HINDU TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS MEDICAL EXPERIMENTATION AND RESEARCH

he key considerations in the Hindu Apprentice surgeons were taught by practicing Tapproach to experimentation would be the incision on gourds; the puncturing and opening of welfare of humanity and whether benefits out- tumours on the bladders of animals filled with weigh the costs. Hinduism generally favors blood and ; the piercing of hollow organs on experimentation,36 and it has even been thick lotus stalks; probing on dried cucumbers described as a spiritual laboratory. The evolu- and worm-eaten ; the application of caustics tion of Hat.ha Yoga and the various a¯sanas on pieces of meat; the giving of enemas on the (physical postures) within it presupposes exten- ends of water-melons; bandaging as practiced on a sive experimentation. doll or clay figure. The stitching of wounds was perfected on soft .38

CLINICAL ISSUES The surgical limits of sentimental benevo- In actual cases, however, the facts of the case lence are also recognized. The Sus´ruta Sam˙hita¯ must be considered carefully. Willing participa- recommends that if the “fetus is irreparably tion in experimentation and research would be damaged or defective and the chances of normal emphasized. Hinduism could, according to cer- birth are nil . . . the surgeon should not wait for tain interpretations, be opposed to vivisection, as nature to take its course but should intervene by for instance in the interpretation of Mahatma performing a craniotomic operation for the sur- Gandhi.37 However, its pluralism allows for other gical removal of the fetus.”39 approaches, while moral aversion has sometimes been accommodated by ingenious ways to teach the practice of surgery.

DEATH AND DYING

eath represents a major point of transition.40 dying in as spiritual a situation as possible is DThis widely shared understanding is rein- emphasized. In Hindu , the remembrance forced in the Hindu tradition for the tradition’s of the of God at the moment of death own . In the Hindu scheme of things, the ensures liberation.43 thoughts at the time of death are considered The social dimension of the event, as distin- determinative of posthumous destiny,41 just as guished from the spiritual, may also be consid- where one goes after leaving a room is often ered. Hindus do not look on death solely as a determined by the thought one has while leav- personal event. The family partici- ing it. Thus the moment of death is pivotal for pates both before (when death is expected) and one’s destiny—either in terms of one’s next life after the end of mortal life with great in sam˙sa¯ra, or for freedom from sam˙sa¯ra. One and grief. The children lose the protection of very well-known account records the rebirth of the father or the elder, or the of the moth- a sage as a deer, because he had become inordi- er, and when a young person (especially a son) nately fond of an orphan pet deer and his dying dies, there is no end to the parents’ misery. thoughts centered on this deer.42 It is also said When a husband dies, the suffers serious that a liberative mind-frame, acquired even at consequences. It is best to die after the debts to the point of death, leads to liberation. Hence , sages, and ancestors have been paid.

THE PARK RIDGE CENTER 11 Death is not the opposite of life; it is the oppo- seem desirable. To the extent that such clarity is site of birth, the two events marking continuing assisted by meditation, or by or passage through the cycle of sam˙sa¯ra. singing, these could be encouraged. Hindus are generally cremated, both because Although heroic death is admired in Hinduism, purifies that which is impure and because alleviation of pain as such is rarely opposed in fire most effectively returns the composite ele- normal circumstances. Yogasu¯tra II.16 clearly ments of the bodies to their original form. The states that may be averted. Neither the ashes are then consigned to the holy ; time nor the form (physical, mental) of suffering performance of this rite is a major obligation is specified in the statement.46 of survivors. Children who die before dentition, Karma is an important consideration in this or before the rite, are considered to context. Some Hindus have been known to die pure; they, along with the renouncers (see refuse pain-alleviation out of concern for work- “Overview of religious morality,” above), are ing out their karma by suffering. Another inter- accorded .44 pretation of the doctrine would, however, suggest It is worth noting that Hinduism does not that pain brought about by past karma could be have as elaborate a scheme portraying passage countered by ameliorative present karma. to the other world as is found in the Egyptian Hospice programs have not been as active in the and the Tibetan Book of the Dead. Hindu as in the Buddhist community.

Forgoing life-sustaining treatment CLINICAL ISSUES Although life should be preserved and pro- longed, the condition of life should also be fac- Determining death tored into the decision at the level of both Modern biomedical questions about determining human and animal life. gener- death have rarely been engaged in Hinduism, ated a huge controversy once by having a calf wherein death is believed to consist of that com- done away because the calf was suffering in ter- plex of diagnostic features which are debated rible agony.47 independently as signifiers of death in the West: The tradition of self-willed death in Hinduism (1) cessation of breathing; (2) absence of cardiac has a bearing on the matters dealt with in both activity; (3) brain stem death. However, as the this section and the next.48 first two phenomena can also be induced through Yoga, the third would be the most , assisted suicide, and euthanasia acceptable criterion. Alongside its aversion to suicide, Hinduism has A case could be made for cessation of body a long tradition of heroic self-willed death. In heat as the final indicator of death according Late , of death was part of to the Hindu Yogic tradition.45 the prevailing image of India.49 Even ¯, the practice in which the widow burned herself on Pain control and palliative care the of the husband (and which was banned Given the importance of the moment of death, in 1829 as equivalent to homicide/suicide),50 and the need for clarity to make the most of it, was viewed in this light. the application of pain control and palliative Thus, according to the Hindu view, it is the care must be judged in this light. Clearly it is “state of mind” which is crucial in such con- inadvisable to be drugged at death. At the same texts. Even in the case of assisted suicide, much time, intense physical pain can also distract the would depend on whether the assister looked mind. Thus amelioration of pain in a way that upon himself as abetting a crime or being party does not adversely affect mental clarity would to a courageous act.

12 THE HINDU TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS Autopsy and post-mortem care Renunciants are buried because they perform As a rule Hindus would like to see the body pre- the rite of for themselves (via an effi- served for the last rites of cremation. However, gy) at the time of their into formal in the case of crime or medical research, consid- (sannya¯sa). erations of or benevolence would be The ceremonies for the departed ancestors, allowed to prevail. called s´ r a¯ddha, are particularly important in Hinduism. A full account of this rite is found in Burial and mourning traditions the Manusmr.ti (III.122-286),51 and it is also In Hinduism, renunciants (sannya¯si¯s) are alluded to in the Bhagavadgi¯ta¯ (.42-44). buried; others (except children) are cremated.

SPECIAL CONCERNS

n another booklet in this series, a distinction Diet has been closely associated with spiritu- Iwas drawn between “two Buddhisms” in ality in Hinduism. Change to a non-stimulating America.52 The first Buddhism is that of Asian- and preferably vegetarian diet was the only , for whom asserting their Buddhist change in life-style required of his followers by a identity as a part of their cultural heritage is an famous modern mystic, (d. important marker of continuity. The second 1950).54 The Hindu religious classic, the Buddhism is that of non-Asian Buddhists, who Bhagavadgi¯ta¯, also contains a reference to diet.55 have converted to Buddhism and for whom the acquisition of a Buddhist identity is a marker of change rather than continuity. RELIGIOUS AND OBSERVANCES One could similarly speak of “two Hindu- isms” in the U.S.A. The first Hinduism is that Hinduism as a religion is characterized by the of Indian-Americans, for whom Hinduism con- celebration of numerous ; prominent stitutes an affirmation of their unbroken identity among these are the festivals of and . with the country of their origin. The second At the same time, Hinduism also provides for Hinduism, then, is that of non-Indian Hindus— many solemn, voluntary ascetic observances. Its those who do not belong to India but have religious rituals and observances thus involve adopted Hinduism as a religion. both “feasting” and “,” with all the impli- cations that both might have for health care.

DIET AND DRUGS

Abstention from non- and alcohol is part of the value system of Hinduism, although this position should not be taken to mean that eating meat and drinking alcohol are considered sinful.53

THE PARK RIDGE CENTER 13 NOTES

1. Bryan R. Wilson, “,” in The India to Hinduism’s silence in the matter; but see Encyclopedia of Religion, ed. (New Lipner, “Classical Hindu View.” York: The Macmillan Press, 1987), vol. 13, 164. 15. William A. Young, World’s Religions, 128. 2. , The Hindu World (: Frederick A Praeger, 1968), vol. 1, 460. 16. S. Cromwell Crawford, Dilemmas of Life and Death (Albany: State University of New York Press, 1995), 3. V.S. Agrawala, India as Described by Pa¯n. ini (: 34. Prithivi Prakashan, 1970), 29; , The World’s Religions (: HarperSanFrancisco, 17.William A. Young, World’s Religions, 128. 1991), 57. 18. Arvind Sharma, “Karma Was Fouled: How Hoddle Did 4. Ainslie T. Embree, ed., The Hindu Tradition (New No Wrong to the Disabled,” , York: Random House, 1972), 74, 221. September 1999, 13.

5. A. L. Basham, The That Was India (New 19. By contrast, in , another Hindu-majority country, : Rupa & Co., 1999: 3rd rev. ed., 1967), 500. women outnumber men.

6. P. V. Kane, History of ´a¯stra, 2nd ed. (Poona: 20. See R. Mutharayappa, M. K. Choe, F. Arnold, and T. Bhandarkar Oriental Research Institute, 1973), vol. 3, K. Roy, Son Preference and Its Effect on Fertility in 816-817. India (Honolulu: East-West Center, 1997); E. Bumiller, May You Be the Mother of a Thousand Sons: A 7. A. S. Altekar, The Position of Women in Hindu Journey Among the Women of India (New York: (Delhi: Motilal Banarsidass, 1995), 206- Fawcett Columbine, 1990), 104. 207. 21. Warren, Gendercide, 85. 8. R. Hassan, Ethnicity, Culture, and Fertility (: Chopmen, 1980), 123. 22. A. Sen, “Population and Gender Equity,” The Nation 271, no. 4 (24-31 July 2000): 16-18. 9. , The Early Upanis.ads (New York: , 1998), 297-298. 23. See Arvind Sharma, “Hinduism and Cloning,” Ecumenism 142 (June 2001): 27-29. 10. See also Arvind Sharma, “Homosexuality and Hinduism,” in Homosexuality and , ed. 24. On the question of karma as it relates to this point see Arlene Swidler (Valley Forge: Press Murray Milner, Jr., “Hindu and the Indian International, 1993), 47-80. Caste System: An Example of Structural Reversal,” The Journal of Asian Studies 52, no. 2 (May 1993): 11. Olivelle, Early Upanis.ads, 157. 298-319.

12. S. Radhakrishnan, The Hindu View of Life (New 25. See Manusmr.ti (VIII.104). Delhi: Indus, 1993; first published 1927), 64. 26. Longevity is valued so much that it even modifies 13. Julius J. Lipner, “The Classical Hindu View on intercaste status. “Even a Bra¯hman.a shall pay rever- ´ Abortion and the Moral Status of the Unborn,” in ence to a Su¯dra above ninety (s´u¯dro’pi ´ami¯m gatah., Harold G. Coward et al., Hindu Ethics: Purity, II.137) . . .” (Agrawala, India as Described, 29). Abortion, and Euthanasia (Albany: State University of Moreover, “‘long life was thought to be the boon of a New York Press, 1989), 41-69. prosperous government’ (IX.246)” (ibid.).

14. William A. Young, The World’s Religions and 27. See Patrick Olivelle, The A¯s´ System: The History Contemporary Issues (Englewood Cliffs, N.J.: Prentice and of a Religious Institution (New York: Hall, 1995), 127. M. A. Warren, Gendercide: The Oxford University Press, 1993). Implications of Sex Selection (Totowa, N.J.: Rowman & Allanheld, 1985), 16, curiously attributes abortions in

14 THE HINDU TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS ¯ 28. The incident occurs in the Aran. yaparva in the 42. See Arvind Sharma, Classical Hindu Thought: An Maha¯bha¯rata. The context is as follows: has Introduction (Delhi: Oxford University Press, 2000), assumed the form of a hawk, and (Fire) has chap. 11. assumed the form of a dove. The hawk wants to devour the dove as its natural food, but the dove has 43. Bhagavadgi¯ta¯ VIII.5. sought in the lap of King S´ivi, whose is being tested by the two gods. In the end, the king 44. N. Desai, Health and Medicine in the Hindu ends up first offering his own flesh in lieu of the dove, Tradition (New York: Crossroad, 1989), 31-32. and, finally, his entire body, rather than abandon someone who has sought shelter with him. 45. So also in Buddhism; see Bimala Churn Law, Concepts of Buddhism (Leiden: Kern Institute, 1937), 93. 29. Herbert Benson, The Response (New York: Morrow, 1976). 46. , Yoga: Discipline of Freedom (Berkeley: University of Press, 1995), 47-49. 30. Heinrich Zimmer, Myths and Symbols in and Civilization, ed. Joseph Campbell (New York: 47. M. K. Gandhi, Hindu Dharma (: Navajivan Harper & Row, 1946); Heinrich Zimmer, Publishing House, 1958), 192-197. of India, ed. Joseph Campbell (Princeton, N.J.: 48. Katherine K. Young, “Euthanasia: Traditional Hindu Princeton University Press, 1969). Views and the Contemporary Debate,” in Coward et al, 31. Ian Stevenson, Cases of the Reincarnation Type Hindu Ethics, 92ff. (Charlottesville: University Press of Virginia, 1975). 49. Wilhelm Halbfass, India and : An Essay in 32. See Sudhir Kakar, The Analyst and the Mystic: Understanding (Albany: State University of New York Psychoanalytic Reflections on Religion and Press, 1988), 12-13. (: Viking, 1991). 50. Vincent A. Smith, The Oxford from the 33. G.P. Malalasekera, Dictionary of Proper Earliest Times to the End of 1911 (Oxford: Clarendon (: Pali Text Society, 1960), vol. 1, 609-610. Press, 1923), 664. ¯ 34. Ainslie T. Embree, ed., Alberuni’s India Translated by 51. “Apastamba attributes the first enunciation of the ´ Edward C. Sachau (New York: W. W. Norton & Co., Sra¯dha Rites to ” (Agrawala, India as Described, 1971), part 2, 189. 3).

35. Ibid, part 1, 80. 52. Paul David Numrich, The Buddhist Tradition: Religious Beliefs and Healthcare Decisions (: 36. David M. Knipe, Hinduism: Experiments in the Sacred Park Ridge Center for the Study of Health, Faith, and (San Francisco: HarperSanFrancisco, 1991). Ethics, 2001), 11.

37. M. K. Gandhi, My Religion (Ahmedabad: Navajivan 53. Manusmr.ti X.126; but see also Agrawala, India as Publishing House, 1955), 81. Described, 28.

38. Benjamin Walker, The Hindu World (New York: 54. , ed., The Teachings of Sri Ramana Frederick A. Praeger, 1968), vol. 2, 455. Maharshi (New York: Arkana, 1985), 139.

39. Crawford, Dilemmas, 32. 55. Bhagavadgi¯ta¯ XVII.7-9; see W. Douglas P. Hill, The Bhagavadgi¯ta¯, 196-197. 40. Sunil K. Pandya, “On Dying and Death: Lessons From the Indian Tradition,” Dilip 28, no. 1 (2002): 23-28.

41. Bhagavadgi¯ta¯ VIII.5-10. See W. Douglas P. Hill, The Bhagavadgi¯ta¯, 2nd ed. (Madras: Oxford University Press, 1973; 1st ed., 1928), 134-135.

THE PARK RIDGE CENTER 15 BIBLIOGRAPHY

Agrawala, V. S. India as Described by Pa¯n. ini. Varanasi: Kakar, Sudhir. The Analyst and the Mystic: Psychoanalytic Prakashan, 1970. Reflections on Religion and Mysticism. New Delhi: Viking, 1991. Altekar, A. S. The Position of Women in Hindu Civilization. Delhi: Motilal Banarsidass, 1995. Kane, P. V. History of Dharmas´a¯stra. 5 vols. Poona: Bhandarkar Oriental Research Institute, 1968-1977. Basham, A. L. The Wonder That Was India. New Delhi: Rupa & Co., 1999. Knipe, David M. Hinduism: Experiments in the Sacred. San Francisco: HarperSanFrancisco, 1991. Benson, Herbert. The Relaxation Response. New York: Morrow, 1976. Law, Bimal Churn. Concepts of Buddhism. Leiden: Kern Institute, 1937. Bhagavadgi¯ta¯. Malalasekera, G. P. Dictionary of Pali Proper Names. Bumiller, E. May You Be the Mother of a Thousand Sons: London: Pali Text Society, 1960. A Journey Among the Women of India. New York: Fawcett Columbine, 1990. Manusmr.ti.

Coward, Harold G., et al. Hindu Ethics: Purity, Abortion, Miller, Barbara Stoler. Yoga: Discipline of Freedom. and Euthanasia. Albany: State University of New Berkeley: University of California Press, 1995. York Press, 1989. Milner, Murray, Jr. “Hindu Eschatology and the Indian Crawford, S. Cromwell. Dilemmas of Life and Death. Caste System: An Example of Structural Reversal.” Albany: State University of New York Press, 1995. The Journal of Asian Studies 52, no. 2 (May 1993): 298-319. Desai, Prakash N. Health and Medicine in the Hindu Tradition. New York: Crossroad, 1989. Mutharayappa, R.; M. K. Choe; F. Arnold; and T. K. Roy. Son Preference and Its Effect on Fertility in India. Embree, Ainslie T., ed. Alberuni’s India Translated by Honolulu: East-West Center, 1997. Edward C. Sachau. New York: W. W. Norton & Co., 1971. Numrich, Paul David. The Buddhist Tradition: Religious Beliefs and Healthcare Decisions. Chicago: Park ______, ed. The Hindu Tradition. New York: Random Ridge Center for the Study of Health, Faith, and House, 1972. Ethics, 2001.

Gandhi, M. K. My Religion. Ahmedabad: Navajivan Olivelle, Patrick. The A¯s´rama System: The History and Publishing House, 1955. Hermeneutics of a Religious Institution. New York: Oxford University Press, 1993. ______. Hindu Dharma. Ahmedabad: Navajivan Publishing House, 1958. ______. The Early Upanis.ads. New York: Oxford University Press, 1998. Godman, David, ed. The Teachings of Sri Ramana Maharshi. New York: Arkana, 1985. Pandya, Sunil K. “On Dying and Death: Lessons From the Indian Tradition.” Dilip 28, no. 1 (2002): 23-28. Halbfass, Wilhelm. India and Europe: An Essay in Understanding. Albany: State University of New York Radhakrishnan, S. The Hindu View of Life. New Delhi: Press, 1988. Indus, 1993.

Hassan, R. Ethnicity, Culture, and Fertility. Singapore: Sen, A. “Population and Gender Equity.” The Nation 271, Chopmen, 1980. no. 4 (24-31 July 2000): 16-18.

Hill, W. Douglas P. The Bhagavadgi¯ta¯. Second edition. Sharma, Arvind. Classical Hindu Thought: An Madras: Oxford University Press, 1973. Introduction. Delhi: Oxford University Press, 2000.

16 THE HINDU TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS ______. “Hinduism and Cloning.” Ecumenism 142 (June 2001): 27-29.

______. “Karma Was Fouled: How Hoddle Did No Wrong To The Disabled.” Hinduism Today, September 1999, p. 13.

Smith, Huston. The World’s Religions. San Francisco: HarperSanFrancisco, 1991.

Smith, Vincent A. The Oxford History of India from the Earliest Times to the End of 1911. Oxford: Clarendon Press, 1923.

Stevenson, Ian. Cases of the Reincarnation Type. Charlottesville: University Press of Virginia, 1975.

Swidler, Arlene, ed. Homosexuality and World Religions. Valley Forge: Trinity Press International, 1993.

Walker, Benjamin. The Hindu World. 2 vols. New York: Frederick A. Praeger, 1968.

Warren, M. A. Gendercide: The Implications of Sex Selection. Totowa, N.J.: Rowman & Allanheld, 1985.

Wilson, Bryan R. “Secularization.” In The Encyclopedia of Religion, ed. Mircea Eliade, vol. 13, 159-165. New York: Macmillan Publishing Company, 1987.

Young, William A. The World’s Religions and Contemporary Issues. Englewood Cliffs, N.J: Prentice Hall, 1995.

Zimmer, Heinrich. Myths and Symbols in Indian Art and Civilization. Ed. Joseph Campbell. New York: Harper & Row, 1946.

______. Philosophies of India. Ed. Joseph Campbell. Princeton, N.J.: Princeton University Press, 1969.

THE PARK RIDGE CENTER 17

Introduction to the series

eligious beliefs provide meaning for people substitute for discussion of patients’ own reli- R confronting illness and seeking health, par- gious views on clinical issues. Rather, they ticularly during times of crisis. Increasingly, should be used to supplement information com- healthcare workers face the challenge of provid- ing directly from patients and families, and used ing appropriate care and services to people of dif- as a primary source only when such firsthand ferent religious backgrounds. Unfortunately, information is not available. many healthcare workers are unfamiliar with the We that these booklets will help practi- religious beliefs and moral positions of traditions tioners see that religious backgrounds and beliefs other than their own. This booklet is one of a play a part in the way patients deal with pain, ill- series that aims to provide accessible and practi- ness, and the decisions that arise in the course of cal information about the values and beliefs of treatment. Greater understanding of religious tra- different religious traditions. It should assist ditions on the part of care providers, we believe, nurses, physicians, chaplains, social workers, and will increase the quality of care received by the administrators in their decision making and care patient. giving. It can also serve as a reference for believ- ers who to learn more about their own tra- ditions. Each booklet gives an introduction to the his- tory of the tradition, including its perspectives on health and illness. Each also covers the tradi- tion’s positions on a variety of clinical issues, with attention to the points at which moral dilemmas often arise in the clinical setting. Final- ly, each booklet offers information on special concerns relevant to the particular tradition. The editors have tried to be succinct, objec- tive, and informative. Wherever possible, we have included the tradition’s positions as reflected in official statements by a governing or other formal body, or by reference to positions formulated by authorities within the tradition. Bear in mind that within any religious tradition, there may be more than one denomination or that holds THE PARK RIDGE CENTER views in opposition to mainstream positions, or FOR THE STUDY OF HEALTH, FAITH, AND ETHICS groups that maintain different emphases. 205 West Touhy Avenue ● Suite 203 ● Park Ridge, 60068-4202 The editors also recognize that the beliefs and values of individuals within a tradition may vary from the so-called official positions of their tradi- The Park Ridge Center explores and tion. In fact, some traditions leave moral deci- enhances the interaction of health, faith, sions about clinical issues to individual and ethics through research, education, and consultation to improve the lives of . We would therefore caution the read- individuals and . er against generalizing too readily. The guidelines in these booklets should not © 2002 The Park Ridge Center. All rights reserved.

20 THE HINDU TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS