Clear Vision Trust

Written for the AQA syllabus by Upeksacitta (Robert Ellis), member of the Western Buddhist Order and a former Head of RS.

Buddhism and Euthanasia

The Buddhist case against suicide and euthanasia

The First Precept

The first ground for thinking suicide wrong according to Buddhist standards is found in the Five Precepts, in the first of which the Buddhist undertakes to refrain from taking life. In Buddhaghosha's commentary, 'taking life' is defined as 'the will to kill anything one perceives as having life' (See Conze Buddhist Scriptures p.70). Killing oneself, or killing another out of mercy, is not explicitly included or excluded from this, so of course it may still be argued that there is an unwritten assumed addition '...except with the consent of the being killed' which would justify suicide or voluntary euthanasia.

The Patimokkha

Slightly more explicit evidence for Buddhist opposition to suicide can be found in the Patimokkha, the summary of monastic rules. Here killing is one of the first-grade offences punishable with expulsion from the sangha, and added to this is

...and this applies also to a monk who incites others to self-destruction, and who speaks to them in praise of death, with such words as "O man, what is the use to you of this miserable life? It is better for you to die than to be alive!

Buddhist Scriptures p.74, Conze

Although this does not say explicitly that a monk who attempts suicide or seeks euthanasia should be expelled, it does seem to show a moral disapproval of suicide by discouraging the propagation of despair or the aiding of suicide. However, it does seem to be motives of despair behind suicide or euthanasia rather than the deed itself which the Patimokkha attacks. Peter Harvey comments that the recognition of dukkha in Buddhism means that suffering and impermanence are to be expected and are thus not an appropriate ground for despair. A Buddhist should accept and work with whatever suffering they find in their lives.

The value of a human birth

Although the Patimokkha is only concerned with monastic ethics, this general argument can be extended further to consider the backward step one takes in voluntarily giving up life as a human being. Buddhist Scriptures stress how rare it is to gain a human rebirth, which offers the better conditions for making progress on the path than any other states within samsara (even those of the gods). The Bodhicharyavatara (the Mahayana text used for devotion by those preparing to take the Bodhisattva vow) compares the chances of gaining a human rebirth to those that a turtle, surfacing from the depths of a great ocean, will happen to rise at the point where a yoke is floating on the surface so as to put its head through that yoke. In the light of this rarity, it is very foolish to voluntarily throw away a human life. To live a human life where the dharma is available is also a great fortune in a world of immense ignorance, so if one has made even the slightest progress on the path this is sufficient to avoid suicide or any other voluntary renunciation of life at all costs.

Applying the Middle Way

The Buddhist view of euthanasia seems to fall midway between the Eternalist Christian view that euthanasia is never justified and the Materialist secular view that it can be justified simply to avoid pain. The Eternalist believes that there is an afterlife which he/she will progress to as an immortal soul. This is the ground on which some Christians argue that euthanasia devalues the process of natural dying and prevents spiritual preparation for the afterlife (which may involve suffering, but this suffering may fulfil a spiritual purpose). Together with this view goes the idea that only God should determine life and death through the processes of nature, so we should not intervene to end our own lives.

On the other hand, the materialist Utilitarian does not believe in any existence beyond death, leading to the (in Buddhist terms) nihilist view that pleasure and pain in this life are all that matter morally. In this case, it seems that all that is required to justify euthanasia is that the person concerned desires it and judges that less pain will result from choosing it than otherwise.

The art of dying well

A traditional Buddhist view, incorporating belief in rebirth, takes the Middle Way between these extremes. On the one hand, there is some agreement with the Christian argument that we should prepare ourselves for death; on the other, it is not agreed that we are not responsible for our own deaths. In the Theravadin tradition, death-proximate karma is most important and will determine the next rebirth, therefore it is important to die calmly, positively and mindfully. In the Tibetan tradition, as recorded in The Tibetan Book of the Dead, death and the interval between death and rebirth (the bardo) provides the opportunity to gain enlightenment, which should be carefully prepared for. The lama is supposed to whisper the text of the book into the person's ear at the time of death and after. This process certainly seems to be ruled out by suicide arising from a depressed or passionate mental state, and it is perhaps for this reason that the Buddha particularly tells monks not to encourage anyone into such a state. On the other hand, it could be argued that voluntary euthanasia, calmly decided upon by a person in a lucid mental state during a terminal illness, may be far preferable to hanging onto life longer with increasing confusion.

The value of suffering

The Buddhist is likely to agree with the Utilitarian, however, that suffering in itself has no value, and disagree with the Christian who argues that it must have value because God has sent it. Facing up to suffering can bring about spiritual progress, as is shown by realisation of dukkha being the first stage on the Spiral Path: however, it must be coupled with faith to be of any practical use, otherwise it merely leads to frustration and the perpetuation of samsara.

Hence the pain of a terminal illness can only be of value if the sufferer has a positive attitude towards coping with it, and judges that he/she will benefit from doing so. In other cases there seems to be no justification for prolonging life unnecessarily. If the dying person lacks faith and confidence, or has them but sees no value in continuing, there is no possibility of further spiritual progress in that life.

The Buddhist case for euthanasia

Ronald Nakasone, a Californian Pure Land Buddhist, provides an argument in favour of some voluntary euthanasia from a Mahayana perspective (see Nakasone Ethics of Enlightenment p.66-81). First he establishes that Buddhist ethics are not based purely on rules, appealing to the account given in the Vinaya of the best way to deal with disputes. This is not just to rely on the letter of rules or even the spirit of rules, but to refer to ones teachers and ones own judgement. Hence, it seems, from the outset, ones judgement on suicide and euthanasia should be made situationally, allowing exceptions to the norm. He then goes on to draw on the Samantapasadika, a Mahayana scripture which gives two examples of the Buddha's attitude to monks contemplating suicide because of a painful disease. In the first, the Buddha stressed that his fellow monks should encourage him to be positive and regard his illness as an opportunity for spiritual practice. In the second, however, he suggests that a monk who decides to die because he is a drain on others may be acting rightly.

Here it is the consequences to others which clearly justify the suicide. However, Nakasone also stresses the principle of autonomy, meaning that in this case it must be the monk himself who decides to end his life. Hence voluntary euthanasia and suicide seem to be justifiable where the motive is the welfare of others rather than simply avoiding pain.

Protest deaths

Nakasone also focusses on the suicides of a number of Buddhist monks in Vietnam who burned themselves to death during the 1960's in protest against the war, and particularly on Chi Mai, a young student who did the same thing (Ethics of Enlightenment p.111-114) . These deaths are also justified in his eyes because they are the actions of Bodhisattvas, showing dauntless compassion in sacrificing themselves for the good of all. Thus, although their actions go against the letter of the first precept, they are justified by the ideal behind that same precept. Nakasone also quotes the Jataka story (given in the Penguin Buddhist Scriptures p.24-6) of the Bodhisattva who fed himself to a hungry tigress in dramatic demonstration of the same selflessness.

The case for euthanasia

If one takes into account the Middle Way and Nakasone’s argument, then, one can make a Buddhist case for euthanasia. Euthanasia can only be justified when it is voluntary, due to the importance of autonomy in Buddhism. With non-voluntary euthanasia we enter a similar debate as for abortion, with the main tradition being firmly against but with some possible arguments on the grounds of compassionately-motivated skilful means. There is no moral difference between suicide and euthanasia on the grounds of who does the action, or between active and passive, natural or unnatural euthanasia, provided the person consents fully and consistently. Euthanasia or suicide, however, is not justified solely as a means of fleeing pain while there is still some real possibility of spiritual progress. Spiritual progress towards nirvana is the highest good and overrules any rules or precepts against suicide, but anyone using this as a justification for suicide or euthanasia needs to do so on the basis of spiritual practice and take great care lest they be deluding themselves. The best justifications for suicide or euthanasia seem to be to avoid being a drain on others and to avoid pain where there is no more possibility of spiritual progress.

Discussion
How far do you think a Buddhist could justify euthanasia in the following cases?

1. An elderly man in great pain, in the final stages of cancer and in a state of great agitation.
2. A Buddhist monk who is likely to die of a terminal disease during the next month, who wishes to die whilst he is still calm and mindful.
3. A woman who has developed Alzheimer’s Disease, who in a Living Will has specified that she wishes to be killed before she reaches the advanced stages of dementia.
4. A man almost completely paralysed by motor neurone disease who believes there is no longer any reason to live and wishes to die.
5. A woman in a persistent vegetative state, with no higher brain functions, from which recovery would be miraculous.
6. A baby who has been born with Tay-Sachs disease and is likely to live only a few days of intense suffering.
7. A man suffering from cancer, who is afraid of further pain and wishes to end his life. Doctors estimate that he will probably live for several months longer and has a 10% chance of complete recovery.