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

An anecdote recounted in this work gives an insight into the present state of Buddhist bioethics. The author relates how she asked the spiritual director of a Tibetan centre in Honolulu whether he thought it was a good idea to donate one’s organs at the time of death. He immediately replied in the affirmative. When asked if the removal of the organs would disturb the dying process, he responded that it would be okay since the doctors could “wait for a few days.” On being informed that the organs had to be removed immediately to save the life of the recipient he “expressed alarm” and changed his mind, advising that for an ordinary Buddhist practitioner organ donation might not be advisable after all (p. 160).

The fact that Tibetan lamas are giving ethical advice on organ donation without even a layman’s knowledge of the medical procedures involved suggests that Buddhist teachers have a lot to learn about adapting traditional teachings to modern contexts. If the problem were simply that many lack scientific knowledge, this could probably be resolved in the short to medium term. The deeper problem, however, is that Buddhism as a tradition lacks the ethical infrastructure needed to address moral dilemmas, particularly those of the complex kind presented by contemporary scientific and medical developments. Despite their undoubted acumen in certain branches of philosophy (notably metaphysics), Buddhist thinkers of the past have consistently failed to probe the moral foundations of their teachings or to establish a theoretical foundation in terms of which moral dilemmas can be analyzed. Not a single treatise on moral philosophy was produced by any of the classical scholars cited in this volume as authorities. Not surprisingly, the legacy of this neglect is that the voice of Buddhism has been almost completely silent with respect to the kinds of ethical issues addressed in this book.

The present work commendably seeks to remedy this absence of information on Buddhist bioethics. This is only the second book ever to attempt such a task, the first being my Buddhism and Bioethics, published over ten years ago in 1996 (reissued by Palgrave in 2002). In the intervening period there have been many scientific advances, such as cloning and genetic engineering, both of which receive attention in the volume under review. While my own approach sought to build bridges by translating Buddhist concepts into the vocabulary of contemporary bioethics, the present volume holds more tightly to the traditional teachings of Tibetan Buddhism. Accordingly, while the concepts and terminology used will be familiar to those inside the tradition, I am not sure to what extent it will facilitate dialogue with bioethicists and clinicians, for whom the colorful and somewhat medieval facets of these teachings may at times seem esoteric.

Before discussing the ethical issues further, it should be pointed out that less than half of the book (chapters 8–11) is devoted directly to bioethics. The first seven chapters are for the most part an account of topics in Mahayana philosophy (such as no-self, dependent origination, and emptiness) and descriptions of the beliefs and practices of Tibetan Buddhism surrounding death. These include meditational practices relating to death and the notion of the post-mortem intermediate state (bardo). Somewhat oddly, chapter 5, titled “Foundations of Buddhist Ethics,” has almost nothing to say about ethics: after a short but potentially interesting section titled “Buddhist Definitions of Life and Death,” it veers off into a lengthy summary of Madhyamaka, Vijnanavada, and Tathagatagarbha doctrines.

Tibetan teachings about death have been summarized in numerous popular volumes in recent years, and it is unclear why such an extended treatment of them is presented again here. The opening sentence of chapter 8 suggests this was necessary to “set the stage for an exploration of bioethical issues from Buddhist points of view,” but the bulk of this material has little connection with bioethics. In particular, it is not clear how it is...