(Paper for Contemporary Human Rights Issues class)
Euthanasia has traditionally been held to be within the religious/ethical/ moral domain. However, as public health is now framed as a human right, the language has allowed euthanasia to be reframed as “the right to die” and debatable outside of its traditional domain.
As a legal issue, it now also crop up in national legislation worldwide, pitting the language of human rights against religious/moral/ethical discourse. The acceptance or rejection of such right must be considered in particular cultural context.
However, so far the issue has been mainly considered in the Judeo-Christian traditions. Its considerations in other religious and cultural context can lead to unique culturally sensitive legislation and practice, and enrich the overall debate.
As Keown (1998) wrote, “In the face of the sharp polarity that has been opened up in the West between those who support and oppose the ‘right to die,’ perhaps its now time to broaden legal horizons and take note of the arguments advanced within other religious traditions, including Buddhism.”
In Thailand, Section 12 of the National Health Act BE 2550 states that: A person shall have the right to make a living will in writing to refuse the public health service which is provided merely to prolong his/her terminal stage of life or to make a living will to refuse the service as to cease the severe suffering from illness. It is foreseeable that the future will bring up cases where the current law will be found inadequate and challenged by patients and relatives to allow assisted suicide and euthanasia, as practiced in Western countries. As a predominantly Buddhist country, Thailand’s Buddhist values will inform and influence the debate in the acceptance or rejection of the right to die.
The first of the five precepts to be observed by all Buddhist lay persons is the refrain from taking human and animal lives, in line with the pan-Indian principle of ahimsa or non-violence. This prohibition is even more apparent in the 227 monastic rules for Buddhist monks where the taking of human lives count as one of the four most serious aggressions which lead to expulsion from the order. It also appears that encouraging someone to commit suicide who then does so is considered as constituting intentional killing of a human being and hence an offence involving ‘defeat’ or ‘expulsion’. (Gethin, 2004).
The prominent Buddhist ethicist Damien Keown -- to whom this paper owes much to – states, “Buddhism’s starting point for reflection on problems in medical ethics, then, is a belief in the inviolability of life as a moral absolute, a moral norm that has no exceptions.” (Keown, 1998) In other words, the human life is a moral jus cogens in Buddhism.
When one analyzed the many stories that appear in the Buddhist Canon, it becomes clear that the arguments based on autonomy, poor quality of life and compassion do not allow derogation from this principle. In one episode, a group of monks came to feel that their bodies were foul and impure. Some committed suicide, while other sought help from “knife-wielders” to take their lives.
Keown (1998) wrote, “The fact that the monks were, as far as we can tell, competent autonomous agents seems to have had no great bearing on the matter. This implies that the principle of the inviolability of life cannot be overridden on the grounds of autonomy. …individuals are not conceived of as autonomous moral legislators.”
In another episode, a man with amputated limbs thought that he would be better off dead. A monk then suggested that his family give a fatal drink to him. The monk was expelled from the order when the man died from that drink. Keown again concluded that, “What is to be respected is the instantiation of life in that person, regardless of the subjective valuation placed up their lives by individuals.”
Even the argument from compassion – often advanced in favor of assisted suicide and euthanasia – is not sufficient. Out of benevolent motive, a group of monks suggested to a sick monk that he had nothing to fear from death. As a result, the sick monk stopped eating and drinking and died. Their offense was considered as incitement to suicide and they were expelled from the order.
Apart from the lay precepts and monastic rules, death plays a central role in Buddhist philosophy. Most important among the Buddha’s teachings are those on the Four Noble Truths which hold the key to the attainment of nirvana. On the role of death, Keown wrote, “Buddhism sees death as an imperfection, a flaw in the human condition, something to be overcome rather than affirmed.
Death is mentioned in the First Noble Truth as one of the most basic aspects of suffering… so a person who opts for death believing it to be a solution to suffering has fundamentally misunderstood the First Noble Truth which teaches that death is not the solution, but the problem.” (Keown, 1998)
This sums up the reason for Buddhist rejection of assisted suicide and euthanasia. Instead, Buddhist societies tend to focus on giving palliative care to terminally ill patients who are in pain. The general attitude is also against using aggressive life support measures to sustain life at all costs. (See Visalo)
It can be said that Buddhism avoids the two extremes of saving life at all costs on the one hand, and using death as the answer for suffering on the other. As much as it doesn’t deny life nor death, it also doesn’t cling to or seek either. The ideal Buddhist way to deal with death is exemplified by the revered Buddhadasa Bhikkhu who refused to receive medical care to extend his life.
Keown (1998) wrote, “Buddhism may thus be thought of as adopting a middle way between two opposing positions. The first is the doctrine of vitalism, which holds that life is an absolute value to be preserved at all costs. At the other extreme is the quality of life view, or the belief that life has no intrinsic value and can be disposed of when its quality drops below an acceptable level.”
He suggested further that, “From a Buddhist perspective, there would be no objection to ceasing treatments that are futile or too burdensome in the light of the overall prognosis for recovery. Neither doctor nor patient is under any obligation to prolong life purely as an end in itself…
Indeed, in Buddhism, clinging to a life that has reached its natural end would be thought detrimental to spiritual progress. Buddhism attaches great importance to a calm and mindful death.” If anything, this Buddhist approach questions the modern medical practices of unnecessarily prolonging life which gave rise to the demand for the ‘right to die’ to begin with. In this way, the Buddhist attitude can be seen as supporting of the right to die in dignity.
Guilty but exonerable?
Although the philosophical position is rather consistent, I would like to propose that Buddhism as a religion can provide some support to Buddhists who choose to go through with their decision to end their terminal lives of pain and suffering. The many stories in the Buddhist Canon shows how common taking one’s own life was even in the Buddha’s time. Three cases of monks who committed suicide were of special relevance to the issue at hand.
Gothika, Vakkali and Channa were said to ‘take to a knife’ to end their own lives. Although some scholars think that these cases showed condoning attitude towards suicide (for example, see Attwood, 2004), I agree with Keown that rather than lauding suicide the Buddha seemed to be exonerate the individuals who commit such acts. (Keown, 1998).
Although the three monks of high attainments made the mistake of crossing the line to seek death, they also made the departure from the attachment to life. Despite their mistakes, they seemed to have made a reflection on the frailty of life and attained enlightenment at the time of death. (It would be wrong to assume, like Attwood, that their nirvana was because of their suicidal efforts.) Their acts were legalistically wrong, but understandable with empathy and compassion.
Although these only pertained to monks with high attainments, it can be argued that they also have relevance to lay persons too. As Martin Witshire (1993) wrote: “Apart from representing putative cases of suicide, these stories share one further overriding theme – each of the protagonists is suffering from a serious degenerative illness… So, when we try to understand why they are exonerated, it is initially necessary to appreciate that their act is not gratuitously performed, but constrained by force of circumstances.” (as quoted in Keown 1998)
In conclusion, the Buddhist jus cogens on the inviolability of human life is against assisted suicide and euthanasia. It advocates better provision of palliative care to ensure that patients face death in a calm and peaceful manner without using unnecessary life support measures to prolong life at all costs.
Therefore, the right to die will face an uphill struggle in Thailand, similar to the issue of abortion. However, the debate will hopefully bring about a more humane treatment of terminally ill patients and, in doing so, render the whole debate a moot point.
Attwood, M. (2004) Suicide as a response to suffering. Western Buddhist Review, 4.
Gethin, R. (2004) Can killing a living being ever be an act of compassion? The analysis of the act of killing in the Abhidhamma and Pali Commentaries. Journal of Buddhist Ethics, 11.
Keown, D. (1996) Buddhism and suicide: The case of Channa. Journal of Buddhist Ethics. 3.
Keown, D. (1998) Suicide, assisted suicide and euthanasia: A Buddhist perspective. Journal of Law and Religion. 1998-1999, XIII
Visalo, P. (2011). Interview. IMAGE Magazine, September, 2011. Available at http://www.visalo.org/columnInterview/5409Image.htm (in Thai).
Wiltshire, M. (1993). The “suicide problem” in the Pali Canon. Journal of the International Association of Buddhist Studies, 6.