A Cross-Cultural Dialogue on Health Care Ethics

7. Buddhist Health Care Ethics

Chapter 7 Buddhist Health Care Ethics Pinit Ratanakul Life and suffering Buddhism has over 2500 years of involvement in medical theory and practice. Its health care ethics is based on its teachings concerning life, suffering, death, and compassion. The following explanation is written within the context of Thai Buddhism but shares much in common with Buddhism worldwide. From the time of the early sangha or monastic communities, Buddhist monks have expressed their compassion through the practice of medicine. The Buddhist perspective on life and death cannot be truly understood apart from the Buddhist laws of causality (paticcasamuppada) and mutation. The relation between "cause" and "effect" in the Buddhist law of causality, also referred to as the law of conditionality, is that of the earlier to the later phase of a single process, hi this context life is an interdependent process of causes and effects, arising, existing, and continuing by the concatenation of psychophysical factors (nama-rupa) mutually conditioning one another. This life 779 120 A Cross-Cultural Dialogue on Health Care Ethics process has no beginning or end and is specifically referred to as the kamma process or the endless cycle of rebirths (samsara)? Death is considered an integral part of existence and is one phase of this cycle. In no sense is death seen as terminating the cycle. In addition to the cause-effect nature of life, Buddhism also emphasizes its impermanence (anicca) and insubstantiality (anatta) through another law of mutation. According to this law everything, whether physical or mental, is by nature transitory and in a constant state of change. Whatever rises must fall. This state of change must thereby result in decline and decay. This is also applied to the life process in which the apparent unity of existence is divided into five aggregates (khandhas, the bits and pieces of muscle and bone, feelings, perceptions, impulses, and the consciousness that make up our personality), each with three traits: arising, remaining, and passing away.2 Owing to this ephemeral nature, life is quite brief and fleeting. But no matter how brief life is, it should be lived fruitfully so that there are no regrets. Along with the frailty and insecurity of life, it is believed that at the centre of existence there is a void. This void is the result of the insubstantial nature of life, and the aggregates, though forming a recognizable and perceivable object, do not produce a substance. All of them are insubstantial and the apparent sameness (identity) is actually the continuity of preceding causes and subsequent effects. Accordingly, for Buddhism the term "self or Ego is a name for the linkage of all five aggregates, just as the term "human being" refers to an aggregate of body and mind. Devoid of a substantial Ego, life is like a bubble, with its centre a void. Apart from its conditionality (cause-effect) and ephemerality, life is suffering (dukha). Suffering is used in Buddhism in a broader meaning to include pain, grief, misery, and dissatisfaction. All these elements of suffering are inherent in the experience of living and cannot be avoided. Owing to this reality, Buddhism concludes that human existence is insecure, fragile, and filled with suffering. The very transitory nature of life is the main cause of suffering, for even happiness is seen to be temporary. While experiencing happiness - which by definition is the absence of pain - one has expectations of the continuation of the state of joy. But these expectations can never be met. The objects of pleasure cannot last long, for they contain within themselves the potential for change and decay. Having undergone change and decay, they cease to give us happiness in their new forms. Although, like happiness, suffering is subject to change and the painful side of experience usually outweighs happiness. But despite this imbalance, life is still precious and the first precept of Buddhism prohibits the taking of life. Within this precept all killing for whatever reason is not allowed. The precept upholds the preciousness of life of all human beings Buddhist Health Care Ethics 727 regardless of the conditions of their lives. As a rule suicide is prohibited. If one destroys one's life in such a way, the great object of one's existence is lost. It is difficult to be born as a human being. In the Buddhist view only human beings can liberate themselves from samsara, the cycle of birth, death, and rebirth. Thus even...