Love in Buddhist Bioethics
Center for Human Resources Development,
45/3 Ladphrao 92 Bangkapi
Bangkok 10310, THAILAND
Eubios Journal of Asian
and International Bioethics 9 (1999), 45-46.
The Buddhist ethical imperative
for physicians throughout the ages is based on love. It is specifically referred
to as loving kindness (metta) or compassion (karuna) which is manifested in of
the practice of loving care. Physicians from the earliest time have been called
upon to practice this Buddhist moral ideal by serving all patients with loving
kindness and having only the benefit of their patients in mind. Loving care is
therefore at the heart of Buddhist health care ethics. When a physician has to
make a difficult decision the primary question he should ask himself is, what
is the most loving action he should take, taking into account all relevant factors?
This means, for example, accepting the patients as full persons with feelings,
beliefs and cultural values and act with due regard to their need in accordance
with moral imperative. In the case of terminal patients the physician's practice
of loving care means giving the best possible treatment, where cure is still reasonably
possible; relieving pain and suffering and comforting them, where cure is impossible;
and finally allowing them to die in dignity. The practice of loving care also
means avoiding paternalism but providing them and/or their relatives with adequate
information about all options regarding the prospect of the patient's health.
This implies respect for the right of the patient to give informed and voluntary
consent prior to any treatment.
In a much wider context, in the allocation
of limited medical resources at the micro-level loving care for a particular patient
needs to be tampered by the concern for others who also need these resources for
their recovery or survival. Similarly at the macro level loving care means a fair
distribution of limited resources throughout the rural and urban areas of the
country. Accordingly loving care embraces justice. This combination is essential
for without justice love is ineffective and sentimental while justice without
love can be rigid and heartless.
From the Buddhist perspective loving care
at the mundane level implies the preservation, protection and restoration of life.
In Buddhism though life in this world is characterized by suffering it is still
valuable. Therefore the first precept prohibits the taking of life in whatever
form. But in the concrete life situation there are many challenges for the physicians
In the practice of loving care for the patients. The most challenging problem
has to do with the need to decide whether the prolongation of life is desirable.
In cases of terminal patients, severely deformed newborns, and those in permanent
vegetative state Buddhist bioethics does not offer clear-cut answers. Some Buddhist
ethicists make a distinction between "killing" and "letting-go-of-life"
Here the important thing is the role of intention on the part of the physician
and/or those concerned. Should life be simply supported when it is very clear
that for the terminal patients or the severely deformed newborns or the PVS patients
they cannot have even minimum quality of life or can survive only at great and
inordinate expenditure of limited medical and other resources as well as energy
and time of health care providers, institution, and the family? For these Buddhist
ethicists in the circumstances mentioned above, "letting-go-of-life"
seems to be the best expression of loving care which is not to be understood as
extending life at all costs. But some Buddhists would argue that "letting-go-of-life"
also violates the first precept. However it is clear that Buddhism is against
euthanasia, the quick, supposedly mercy killing to relieve pain. With regard to
the argument that one is seeking to hasten the death of another in order to be
merciful or to show loving-kindness. Buddhism considers it a form of paternalism
and self deception People nave different pain thresholds and psychological, emotional
and spiritual factors play a great part in how much pain or suffering people can
endure. People can endure pain if they find meaning in it. We might think that
another is suffering unendurable pain and therefore ought to die. In this we are
paternalistically imposing our values upon them because we would not want to go
on living in such circumstances. But this does not mean that this, even a painful
life, is meaningless to them. In Buddhist psychology, the felt desire to end another's
suffering may be derived from our own inability to cope with it, and our own anguish
in watching another suffer. Actually, we want to save ourselves from further suffering,
not them. Instead of euthanasia the practice of loving care to the dying means
helping them to reach their end peacefully and, if possible, in the wholesome
state of mind.
In the case of abortion loving care means avoiding condemning
those women whose life situations have made the decision to abort seems unavoidable,
and treating them with understanding and sympathy. This precludes any form of
assistance given in the process of abortion. Even when the fetus is known to be
severely deformed the fetal abnormalities cannot be used as grounds for abortion.
In this case loving care is extended to the unborn. This extension raises the
question whether loving care means that the unborn babies who, if allowed to be
born, are more likely to die an agonizing death, should be aborted to prevent
suffering inflicted on them and on the family. This is a difficult question Buddhist
bioethics has to deal with to help the Buddhists in the practice of loving care
to suffering people. In the life cycle (samsara) fraught with the potentiality
and actuality of human suffering the relief of human suffering is the primary
moral virtue. To alleviate the suffering of the parents prenatal diagnosis to
detect genetic disorders of the fetus should be encouraged for married couples
to prepare them for the proper attitude towards deformed babies, when it is inevitable.
And to prevent suffering to be inflicted on parents those known to be carriers
of genetic diseases are advised to forego parenthood and seek other means of having
children, if they so desire.
It may be concluded that in Buddhist bioethics
love occupies a central place. It is the basis of the foremost Buddhist moral
principle, namely, loving kindness or compassion which leads to the practice of
loving care. Loving care does not mean mere protection of life as it involves
complex factors to be reckoned with. In the discussion of the right to life among
Buddhist ethicists the present trend is to bring the Buddhist concept of interdependence
(patichasamuttipada) into such discussion. Following this teaching of interdependence
of all being as. Buddhists see human actions in the totality of their circumstance
and human responsibility in the inter-webbing of relationships of self to self,
others and society. Accordingly although the final decisions concerning his/her
life should be made by each person these decisions are to be made in consideration
of the suffering the decisions would inflict on other individuals, families, and
Of course, there are people who will question whether loving care
alone is sufficient basis for making ethical decisions in the practice of modern
medicine. To this question it should be pointed out that the Buddhist concept
of loving care is a comprehensive notion embracing all other moral principles
uphold in western bioethics i.e. respect for persons and their autonomy, beneficence,
non-maleficence, and justice. In Buddhist bioethics the principle of loving care
is emphasized more than other moral principles because Buddhism recognizes the
complexity of life situations where legalistic observation of moral rules can
unintentionally lead to greater evils and abdication of compassion. In real life
there are many cases which are in the twilight zone. In such cases the nature
of intention behind deed is of primary significance and thus should be taken into
account before we rush in negative judgment on the party concerned. When life
situations force people to make unpleasant decisions, hard choices between greater
and lesser harms, greater and lesser good, we should not overburden them with
a sense of guilt but evaluate the reality with compassion to lessen their suffering
caused by wrong decisions. Only by avoiding the rigidity and laxity can the practice
of compassion be achieved. Where would society be, where would medicine be were
it not for the example of those who practice the Buddhist ideal of loving kindness
or compassion consecrated themselves to the welfare of others even at the cost
of their own comfort and benefit.
Is it now the time for a paradigm shift
from the over-emphasis on individual rights to loving care as a moral imperative
in the practice of medicine and in other areas of life?