Into the Jaws of Yama, Lord of Death: Buddhism, Bioethics, and Death

11. Bioethics in a Rapidly Changing World

Chapter 11  Bioethics in a Rapidly Changing World The great mystery of death has engaged the human imagination since the beginning of time, but never before have human beings exerted as much control over their own dying as now. Human beings are perhaps the only mammal with sufficient intelligence to contemplate whether and when it is permissible to take their own lives when death approaches, and they still have not come to any consensus on the matter. Throughout history, the question of whether and when life may defensibly be terminated—whether in war, at birth, in vitro, in prison—has been contested from various perspectives and people are often inconsistent, opposing death in one instance and advocating it in another. Now that technologies of living, dying, and biological reproduction have become so complex, the debates are more heated than ever. An intelligent discussion about the issues not only requires expertise in a range of areas and disciplines, but also the mental flexibility and openness to consider alternatives. The pivotal question, germane to all subsequent discussions, is: “When does life begin and when does it end?” But on this issue, again, there is no consensus. In recent decades, medical science has developed certain criteria to determine when the brain is capable of supporting consciousness and when the fetus can survive outside the womb. Medical science has also developed criteria to determine when the brain is no longer capable of supporting consciousness, though these criteria are not universally accepted. The question of when an embryo or fetus becomes or ceases to be a person remains a matter of widely divergent opinion. 209 210 Into the Jaws of Yama, Lord of Death Traditional Buddhist perspectives on taking life and hastening death are fairly straightforward. The first precept, to avoid taking life, provides a reference point from which ethical decisions can be made. Negotiation and understanding are preferred to violence, even in a violent or life-threatening situation, and many Buddhists would prefer to be killed than to kill another human being. Today, however, medical science has raised many challenging questions for which there are as yet no definitive Buddhist answers. Questions about bioengineering and genetic cell transfer open up unfamiliar ethical landscapes that require new interpretations of ancient texts and teachings. The most basic Buddhist criteria for ethical decision making are the principles of nonharm and compassion, grounded in a set of fundamental assumptions about the world and the role of human beings within it. Although there are many divergent streams of Buddhist thought and practice, all accept some interpretation of the law of cause and effect and rebirth, not of the continuity of a personal identity, but of the momentum of an individual’s actions from one lifetime to the next. Because the cycle of rebirth encompasses not only human beings but other forms of sentient life as well, the scope of ethical considerations is broader than from many other perspectives. Extending the scope of reference in this way adds further moral, legal, and economic complexity to an already complicated set of issues. The challenge for bioethicists today is to provide a foundation for ethical decision making that is clear enough to guide moral thinking , and flexible enough to accommodate the range and complexity of new technologies and the biomedical dilemmas they raise. Traditional Buddhist thinking was based on the ethical injunctions attributed to Buddha Íåkyamuni and on the commentaries of learned scholars and practitioners written over a period of more than two millennia. The Buddha’s injunction to avoid taking life, especially human life, including the life of a fetus, serves as a fundamental principle for Buddhists around the world even today. His further injunction to refrain from encouraging or abetting the taking of life underscores the fundamental importance of the principle of nonharm. These straightforward injunctions have provided standards for making decisions of such matters as reproductive health and end-of-life care. Even today, individual Buddhists seek the advice of scholars who are knowledgeable about the monastic codes (Vinaya) and other ethical treatises. These codes and treatises are now being reexamined in light of shifting value systems, new medical technologies, and nontraditional lifestyles that make moral choices more complex than in the past. Time and again, the Buddha modified the original formulation of a precept to reflect a different set of circumstances. For example, the Bioethics in a Rapidly Changing World 211 precepts that the Buddha is...