Thursday, January 1, 2009

Euthanasia I

Recently there has been widespread discussion in Singapore about the pros and cons of euthanasia. The government originally broached the subject, probably in response to rising health costs, and various medical and religious bodies have given their opinions on the matter. On Nov. 4th the Straits Times reported that Christian, Muslim and Buddhist religious authorities were opposed to any form of euthanasia and that Hindus were (on going to press) unable to give an opinion one way or the other. I suspect this means that they were simply unable to find anyone who could speak authoritatively on the matter, a sad reflection on the state of Hinduism in Singapore. Venerable Kwang Phing of the Singapore Buddhist Federation was asked for the Buddhist position and said that Buddhism would consider euthanasia to be unacceptable. I do not know exactly what Ven. Kwang Phing said but I would like to give some of my own thoughts on the issue.
I will use the word euthanasia here to mean intentionally killing a terminally ill patient by performing or withholding medical procedures. Euthanasia can be either active, e.g. administering a lethal injection, or passive, e.g. no longer feeding an unconscious patient. It can also be either voluntary, e.g. requested by the patient, or non-voluntary, e.g. where the patient is unconscious and a legally competent person makes the decision. Thus there are four types of euthanasia – active voluntary (AVE), passive voluntary (PVE), active non-voluntary (ANE) and passive non-voluntary (PNE). There is also what is now called voluntary suicide (VS), where the care-giver provides the patient with the means of killing himself or herself but has no involvement beyond that.
There are three main arguments in favour of euthanasia -
The Compassion Argument. If someone is in extreme pain and going to die soon anyway, or if they are brain dead, it is compassionate to both them and their family to end their life.
The Choice Argument. Our life is our own and no one has the right to tell us what to do with it if we are not interfering with the welfare of others. If I choose to end my life I should have the right to do so.
The Economic Argument. The cost of keeping terminally ill patients or brain dead patients alive for as long as possible is driving up the health care costs for those who are only curably ill.
To my mind the first of these arguments is the strongest and the last one the weakest.
There are five main arguments against euthanasia -
The Moral Argument. Killing for any reasons is wrong. It is just another type of murder.
The Unprofessional Argument. The whole rationale of the medical profession for centuries has been and is to enhance and preserve life. In asking or allowing doctors or nurses to kill patients we are compromising the most fundamental ideal of the medical profession.
The 'How Can We Know?' Argument. We cannot know for sure that a terminal patient is going to die as quickly as the doctors predict. Doctors are sometimes wrong. We cannot know for sure that a brain dead or long-term unconscious patient is going to remain in that state. They sometimes suddenly wake up. When a terminal patient asked to have their life ended we cannot know for sure that they are making a truly free choice. Perhaps they feel guilty that their medical expenses are becoming a burden for their family.
The Slippery Slope Argument. If we allow euthanasia, where will it stop? Then there might be calls to kill the elderly or physically and mentally disabled people.
The Mythological Argument. Life was created by God and is therefore sacred and no one has the right to take it except God.
I have arranges these arguments from most to least valid. The last two are equally unconvincing in my mind.
Is there anything in the Buddha's Dhamma that could help come to some conclusion on the admittedly very complex issue of euthanasia? The usual Buddhist argument used in the euthanasia debate is that it is always negative to take a life - full stop. One text that is often used in such discussions is this one from the Vinaya which seems to directly address the question of euthanasia. 'Should any monk (or nun) intentionally deprive a human being of life, or search for a killer for them, or praise the advantages of death, or incite them to die saying, "What use is this wretched and miserable life to you? Death would be better for you than life", or with a similar idea, a similar purpose in mind, should in various ways praise the advantages of death or incite them to die, he also is excommunicated and no longer within the monastic community' (Vin.III,71-2). However, seen within its context, I feel that this text does not really contribute much to the euthanasia debate. Firstly, the origin story of this rule tells us that some monks encouraged a sick man to kill himself so that they could get up to mischief with his wife (Good God! That’s what some of the recruits to the Sangha were like then). Secondly, there is no suggestion that the man was terminally ill, that he had expressed the desire to end his life and the monks intentions in getting him to do so were clearly negative and without concern for the sick man. Thirdly, there are several passages in the Vinaya that stipulate clearly what a monastic's role is and making it clear that monks and nuns should stick to that role and not stray into other roles. So the question of counseling a patient on the pros and cons of euthanasia or any medical questions is not a monastic's job and he or she should have nothing to do with it. But what about doctors, care-givers, terminally ill patients and their loved ones who are not monks or nuns? I will continue this discussion tomorrow.


Anonymous said...

Happy New Year Venerable Sir,

Thank you as ever for your teaching. I do want to point out two places you gave me a chuckle -- and both were in your parenthetical "Good God! That’s what some of the recruits to the Sangha were like then"

After mentioning God within the context of a mythological argument, it's funny to then use that exclamation. And of course, recruits to the Sangha have never been not like that, since there are always rotten apples. I remember when I visited Kyoto and learned the monks from opposing temples would make war on each other. So much for all beings being peaceful. Well. In any case, a most auspicious year of the ox to you. And I look forward to more of your always thought provoking musings.

Shravasti Dhammika said...

Dear Tzohar21
Thanks for the appreciative message and the New Year blessing. Sometimes I say 'Jumpin Josephus' without believing that old Jo was a jumper, and sometimes I say that something is 'in the lap of the gods' without…you get the idea. Anyway, I'm glad to know that an old radical like you finds my blog readable. May the coming year bring peace, contentment and happiness to you.