Euthanasia in Buddhism and Christianity

·期刊原文

Killing, karma and caring: Euthanasia in Buddhism and Christianity

by Damien Keown

Journal of Medical Ethics

Vol. 21 No.5 Oct.1995 Pp.265-269

Copyright by Journal of Medical Ethics

Abstract

In 1993 The Parliament of the World's Religions produced a declaration
known as A Global Ethic which set out fundamental points of agreement
on moral issues between the religions of the world. However, the
declaration did not deal explicitly with medical ethics. This article
examines Buddhist and Christian perspectives on euthanasia and finds
that in spite of theft cultural and theological differences both
oppose it for broadly similar reasons. Both traditions reject
consequentialist patterns of justification and espouse a 'sanctity of
life' position which precludes the intentional destruction of human
life by act or omission.

Introduction

The religions of the world are becoming increasingly aware that what unites
them in ethics is greater than what divides them in theology. An
interesting counterpoint to the disintegration of moral consensus in the
postmodern world can be seen in the impetus towards dialogue and mutual
understanding on the part of traditions which for much of their history
have been antagonistic. As they search their ancient teachings for
solutions to contemporary dilemmas, Christians, Muslims and Jews are
becoming increasingly aware of the common ground they share. The consensus
which is emerging in key areas suggests that scepticism regarding moral
objectivity may be misplaced.

The moral consensus among religions was given expression in a codified form
by the Parliament of the World's Religions which met in Chicago in late
1993. The parliament produced a declaration which reveals an impressive
degree of accord. The declaration states: 'We affirm that a common set of
core values is found in the teachings of the religions, and that these form
the basis of a global ethic' (1). In its affirmation that there is 'an
irrevocable, unconditional norm for all areas of life, for families and
communities, for races, nations and religions' (1) it characterises these
core values as objective and universal moral truths.

Adding further weight to the suggestion that a consensus on ethical
fundamentals exists among the major religious traditions are the views of
the eastern religions, whose voice has been little heard to date. Perhaps
the most influential of these is Buddhism, a religion whose adherents in
Asia number roughly 500 million and which is rapidly making inroads in the
West. Arnold Toynbee has described the encounter between Buddhism and
Christianity as 'one of the greatest collisions of the 21st Century,' (2)
and although it is too soon to predict the outcome of this encounter it is
undeniable that it will be of significance. The purpose of this paper,
however, is not to speculate about the future, and is limited to indicating
the existence of common ground in one specific area of medical ethics,
namely euthanasia. By 'euthanasia' we mean the intentional killing of a
patient by act or omission as part of his or her medical care. We are not
concerned, therefore, with either the administration of palliative drugs,
or the withdrawal of futile or excessively burdensome treatment, which may,
as a foreseen side-effect, hasten death.

Buddhist ethics

Reliable information on Buddhism has been available in the West for less
than a century and a half and the study of Buddhist ethics is a nascent
discipline. The existence of alien traditions such as Buddhism has long
been seen as providing evidence of moral diversity and support for moral
relativism. A closer examination, however, suggests that this view is
mistaken. What is particularly striking in the case of Buddhism (3) is that
despite its different theological premises (most radically its denial of
both a supreme being and the soul), it reaches ethical conclusions which
are very similar to those of the Semitic religions.

In terms of the categories of Western ethics Buddhism could best be summed
up as a teleological virtue ethic. Its nearest analogue would be
Aristotle's eudaimonism as developed in the tradition of natural law (4).
In its teachings on karma Buddhism affirms that every moral act has both
transitive and intransitive effects. The transitive effects are seen in the
impact our moral choices have on others, while the intransitive effects are
the changes in the character of the subject brought about through the
performance of virtuous or wicked deeds. The doctrine of karma also holds
that the circumstances of rebirth are determined by an individual's moral
status at death. This means that the hedonic tone of any given existence is
conditioned by antecedent moral deeds. While moral actions produce pleasant
and unpleasant consequences in the form of transitive and intransitive
effects, however, the moral status of an act is not determined by its
consequences. For Buddhism this is determined instead by the conformity
between what is intended and the eternal moral law (Dharma), the
requirements of which can be known through scripture and reason (5).

The sanctity of life

Buddhism's approach to medical ethics is informed by its belief in the
sanctity of life. This pan-Indian belief finds ethical expression among the
major religious traditions in the form of the principle of non-harming
(ahimsa). In the case of Buddhism, which is atheistic, respect for life is
grounded not in its divine origin but in its spiritual destiny, namely the
state of final perfection known as nirvana. From this affirmative valuation
of life flow precepts forbidding its intentional destruction (6).

Despite its highly sophisticated psychology Buddhism makes no attempt to
distinguish certain faculties as indicators of moral personhood. Existence
is a continuum of changing states: all states are impermanent, and the
possession or absence of certain faculties or qualities in the course of a
determined psycho-physical existence is of no moral significance.
Individual life in any one existence begins at conception and ends at
death: in the interval between the subject is entitled to full moral
respect regardless of the stage of psycho-physical development attained or
the mental capacities enjoyed (7).

Euthanasia

No euphemism such as 'euthanasia' is found in early Buddhist canonical
sources, nor is the morality of the practice discussed specifically in the
discourses (sutta) of the Buddha (8). As an act or omission involving the
intentional destruction of life, however, it would undoubtedly be
prohibited by Buddhist precepts. Confirmation of this can be found in the
Monastic Rule (Vinaya), a corpus of canonical literature which sets out the
regulations governing monastic life. The Monastic Rule is an authoritative
source for Buddhist ethics, and includes a body of case law in which the
Buddha is represented as giving judgment on specific matters. The cases
relevant to euthanasia are recounted under the rubric of the precept
against the destruction of human life (the third parajika). The penalty for
breaking the precept is the severest which can be imposed: lifelong
excommunication.

The circumstances leading to the promulgation of this precept have a direct
bearing on euthanasia. The Buddha included it in the monastic code on
discovering that a number of monks had either killed themselves or asked
others to kill them after developing disgust for their bodies, an attitude
not unknown in ascetic traditions. Some monks committed suicide, some
killed one another, and others invoked the aid of an assistant from outside
the order who killed them with a knife. When the Buddha found out he
immediately took action to prevent any recurrence by introducing a precept
forbidding the destruction of human life. The precept expressly forbids
both killing a human being and seeking assistance in dying (literally
'looking for a knife-wielder') (9).

The promulgation of the precept in these circumstances suggests that
voluntary euthanasia (that is, euthanasia at the individual's request) is
immoral from a Buddhist perspective. The fact that the monks were
autonomous agents seems to have had no beating on the matter, which implies
that the principle of the sanctity of life cannot be overridden by an
appeal to autonomy. It is arguable that the prohibition was introduced
because the monks who sought euthanasia in the case in point had done so
under the influence of religious zeal and without due time for sober
reflection. This argument is, however, unpersuasive, since the precept
imposes an unqualified prohibition. Such a prohibition is, moreover, quite
consistent with the corpus of early Buddhist ethical teachings which do not
contemplate any circumstances in which the destruction of life might be
condoned (10). In addition there are further cases in the Monastic Rule
itself where the immorality of euthanasia clearly does not turn on the
absence of due consideration. Certain of these cases involve 'quality of
life' issues: one concerns terminal care (11), and two the long-term care
of patients with serious disabilities (amputated limbs) (12).

The most interesting of these cases is the first, the one involving
terminal care. The motive is stated to have been compassion for the
suffering of a dying monk. According to the influential fifth-century
commentator Buddhaghosa, those found guilty in this case took no direct
action to terminate life but merely suggested to a dying monk that death
would be preferable to his present condition. Despite this apparently
benevolent motive, namely to spare a dying person unnecessary pain, the
judgment handed down was that those involved were guilty of a breach of the
precept. What had they done wrong? In Buddhaghosa's view the essence of
their wrongdoing was that the guilty monks made death their aim
(Va.ii.464). It would therefore appear immoral from a Buddhist perspective
to embark on any course of action whose aim is the destruction of human
life, regardless of the agent's motive (13).

The circumstances in which the precept was promulgated and the cases
referred to above are directly relevant to the two main grounds on which
euthanasia is thought by some to be justifiable, namely beneficence, either
in alleviating pain or terminating life which is no longer thought to be a
benefit, or respect for autonomy. The canonical evidence suggests that
neither of these grounds provides justification for euthanasia from a
Buddhist perspective.

The above does not, however, commit Buddhism to the view that life must be
preserved at all costs. Buddhism is only too aware of the fragile and
transitory nature of life, but as individual life is a continuum which
constantly re-manifests itself Buddhism does not seek to prolong it by
artificial means simply because it is technologically possible. There is
accordingly no requirement to carry out futile or unduly burdensome
treatments, such as resuscitating the dying. The intentional hastening of
death is, however, morally unacceptable in all circumstances.

Christian ethics

Given the number of Christian denominations, and their more or less varying
traditions, it is hardly surprising that not all Christians agree on all
ethical issues. The major Christian tradition, Catholicism, subscribes to
an ethics based on natural law, whereas the Lutheran churches do not.
Nevertheless, both traditions would join in rejecting a consequentialist
ethic, one which holds that the morality of an action turns solely on its
consequences, an ethic advanced by a number of prominent contemporary
bioethicists.

The Christian tradition rejects such bioethicists in favour of St Paul, who
taught that certain conduct is intrinsically wrong and should be avoided
regardless of any good consequences that might flow from it. In short, a
good end does not justify a bad means: evil may not be done that good may
come of it (14). Christian ethics holds that, while consequences may well
be relevant in assessing the morality of an act or omission, the morality
of an act or omission is not determined by its consequences. So whereas the
Christian rules out, say, torturing children as intrinsically wrong, the
consequentialist does not. This is not the place to critique
consequentialism; its incoherency has been exposed elsewhere (15). Our
purpose here is simply to note the consensus among Christians and Buddhists
in rejecting the consequentialist ethical approach which typically
underlies the case for the legalisation of euthanasia.

The sanctity of life

Few ethical concepts are more widely misunderstood or persistently
misrepresented than that of the 'sanctity of life'. As developed and
understood in Christian thought, it holds that as life is a gift from God
it is to be cherished. As explained by the Anglican and Catholic bishops in
their joint submission to the House of Lords Select Committee on Medical
Ethics (a submission which states that it would also enjoy the support of
the Free Churches): 'All human beings are to be valued, irrespective of
age, sex, race, religion, social status or their potential for achievement'
(16) and 'the deliberate taking of human life is prohibited except in
self-defence or the legitimate defence of others' (17). In this
understanding, which roots the fundamental value of each human being in his
or her creation by God and in the image of God (but which can also be
articulated in purely secular terms) human life is a basic good as opposed
to an instrumental good: a good in itself rather than as a means to an end,
whether that end be conceived of as life of a certain minimum 'quality', or
the good of the state, or anything else.

Life is not, however, considered to be an absolute value, in the sense that
it must be preserved at all costs. As the bishops make clear: 'Neither of
our Churches insists that a dying or seriously ill person should be kept
alive by all possible means for as long as possible' (18). They add that it
can be perfectly proper to administer palliative care even if it
incidentally shortens life. Adverting to the doctrine of 'double effect',
they note that 'There is a proper and fundamental ethical distinction. . .
between that which is intended and that which is foreseen but unintended'
(19).

Euthanasia

The principles sketched above explain the basis of the Christian opposition
to euthanasia. As the wrongness of intentional killing obtains regardless
of the consequences, that opposition applies whatever the condition of the
patient. As the joint submission states, the vulnerable deserve not less
protection, but 'special care and protection' (20). Adherence to this
principle, it adds, 'provides a fundamental test as to what constitutes a
civilised society' (20).

Even euthanasia at the patient's explicit request is to be prohibited. The
right to personal autonomy is not absolute: 'It is valid only when it
recognises other moral values, especially the respect due to human life as
such, whether someone else's or one's own' (18). Moreover, the exercise of
autonomy has to be limited in order that human beings may live together in
reasonable harmony.

Allied to this principled objection to voluntary euthanasia are two other
objections which focus on the undesirable consequences of tolerating it.
First, that 'it would be difficult to be sure that requests for euthanasia
were truly voluntary and settled, even if safeguards were built into the
legislation, and not the result either of depression or of undue pressure
from other people' (21). Second, that it would result in a breakdown of
trust between doctor and patient (22).

It would be a grave error to perceive the Christian opposition to
euthanasia as a rejection of the problems of the terminally ill. The
submission notes that the hospice movement grew out of the concerns of
Christians that people should be helped to die with dignity and it urges
that the lessons learned in hospices should be applied throughout the
health service to all dying people (23). It concludes that it is killing,
rather than caring, which denies the dignity of the dying.

Conclusion

Five main conclusions may be drawn about euthanasia in Buddhism and
Christianity. First, despite the widely different cultural background and
theological presuppositions informing both religious traditions, there is a
striking similarity in their opposition to the intentional killing of
patients. Secondly, this opposition is not coincidental but derives from
their shared rejection of consequentialist reasoning in favour of an
ethical approach grounded in a respect for human life as a basic as opposed
to an instrumental good. Thirdly, notwithstanding this shared absolute
opposition to euthanasia, both religions teach that life is not an absolute
value to be preserved at all costs and both emphasise the transistory
nature of earthly existence. Fourthly, the remarkable consensus between
these major but disparate religious traditions calls into question
prevalent assumptions about the impossibility of moral consensus in the
modern world. Finally, the common conclusions identified by this
investigation of the issue of euthanasia lends support to the conviction
articulated in the declaration of the Parliament of the World's Religions
that a common set of core values may be found in the teachings of the world
religions.

Key words

Death and dying; religious ethics.

References and notes

(1) Kung H and Kuschel K J, eds. A global ethic. The declaration of the
parliament of the world's religions. London: SCM Press, 1993: 14. Other
recent discussions include Runzo J, ed. Ethics, religion and the good
society: new directions in a pluralistic world, Louisville: John Knox
Press, 1992; Outka G, Reeder J P, eds. Prospects for a common morality,
Princeton: Princeton University Press, 1993. A selection from the speeches
made at the first parliament in 1893 may be found in Seager R H, ed. The
dawn of religious pluralism. Voices from the world's parliament of
religions, 1893. La Salle, Illinois: Open Court, 1993. The declaration is
not, of course, a comprehensive exposition of the views of the signatories.
Some find the declaration incomplete in certain respects. See, for example,
Waldau P. Beyond praise of the 'declaration of the parliament of the
world's religions'. Studies in interreligious dialogue 1995; 5: 76-89.

(2) Toynbee A. Christianity among the religions of the world London: OUP,
1948:14. See also Keown D. Christian ethics in the light of Buddhist
ethics. Expository times 1995; 106, 5: 132-137.

(3) There are many schools of Buddhism and no central authority on matters
of doctrine. There is, however, a consensus on ethics among the main
schools. For the purposes of this article the Theravada School, which is
the oldest and most orthodox of the surviving traditions, is taken as
representative of the Buddhist position.

(4) See Keown D, The nature of Buddhist ethics. London: Macmillan, 1992.

(5) The Buddhist term is prajna which might be translated as 'rational
insight'. Like the Greek sophia, prajna denotes the cognitive faculty whose
function is the intuitive apprehension of truth. Prajna is not a
self-validating mystical intuition and is always grounded in, and
justifiable through, reason.

(6) A fuller discussion of these matters may be found in Keown D.d
bioethics. London: Macmillan, 1995: ch 1.

(7) For a fuller discussion see reference (6): Buddhism and bioethics:
21-36.

(8) Secondary literature on the subject is also scant. The most useful
article to date is Florida R E. Buddhist approaches to euthanasia. Studies
in religion/sciences religieuses 1993; 22: 35-47, which contains references
to most of the available sources.

(9) The precept states: 'If any monk should intentionally deprive a human
being of life or look for a knife-wielder he commits the offence of defeat
(parajika) and is no longer in communion' (Vinaya iii.71). The instrument
used is of no significance: the embedded commentary explains that the
lethal instrument may be a knife, a dagger, an arrow, a cudgel, a stone, a
sword, poison or a rope (Vinaya iii.73).

(10) Even killing in self-defence appears to be ruled out (Anguttara.iv.
188).

(11) Vinaya.ii.79.

(12) Vinaya.ii.86.

(13) In Buddhism, as in other religions, there exists the category of mots
voluntaria religiosa. This relates to cases where pious individuals or
saints, often under the influence of religious zeal, sacrifice their lives
for some religious end. Three notable cases are found in the Pali canon,
and many more (often fictitious) are scattered throughout later literature.
Although these examples are sometimes thought to show that Buddhism
condones suicide (and would therefore invalidate the principle stated
above) we think it would be unwise to draw normative conclusions from these
examples, especially since suicide is elsewhere clearly prohibited (for
example by the First Precept and also by the Monastic Rule, as seen above).
A brief discussion of the anomalous category of voluntary religious death
and its implications for ethics will be found in Buddhism and bioethics:
58-60. For a discussion of voluntary death in the context of another Indian
tradition, Jainism, see Bilimoria P. The Jaina ethic of voluntary death.
Bioethics 1992; 6: 330-355. With reference to Judaism and Christianity see
Droge A J, Tabor J D. A noble death: suicide and martyrdom among Christians
and Jews in antiquity. San Francisco: Harper Collins, 1991. With reference
to classical antiquity see van Hooff A J L. From autothanasia to suicide.
Self-killing in classical antiquity. London: Routledge, 1990.

(14) The Holy Bible. Letter of Paul to the Romans, 3:8.

(15) See, for example, Grisez G. Against consequential-ism. American
journal of jurisprudence 1978; 23: 21-73; Finnis J M. Fundamentals of
ethics. Oxford: OUP, 1983: ch IV.

(16) Joint Submission of the Anglican and Catholic Bishops to the House of
Lords Select Committee on Medical Ethics. Euthanasia - no! London: The
Incorporated Catholic Truth Society, 1993: para 3.

(17) See reference (16): para 13.

(18) See reference (16): para 8.

(19) See reference (16): para 14.

(20) See reference (16): para 4.

(21) See reference (16): para 12.

(22) See reference (16): para 17.

(23) See reference (16): paras 20-21.