A Cross-Cultural Dialogue on Health Care Ethics

2. Buddhism, Health, Disease, and Thai Culture

Chapter 2 Buddhism, Health, Disease, and Thai Culture Pinit Ratanakul Therevada Buddhism, also known as the Hinayana tradition, has been considered the core of Thai national identity since the establishment of the first Kingdom of Sukhodhaya in the thirteenth century. Though the present constitution does not make it compulsory for every Thai to follow the Buddhist beliefs and practices, it requires the king to be a Buddhist. For the vast majority of the Thai population one cannot be a true Thai without being a Buddhist. Since early times the Thai sangha, the order of Buddhist monks, has been integrated into the state structure to provide legitimation for the monarch and/or political rulers. The institution of kingship, Buddhism, and nation are considered as the basic triad of social solidarity and identity. They have been so intermingled in the course of history and are so deeply meaningful to the hearts of the people as to form the dominant core of Thai culture. In this culture, although one may notice the elements of Brahmanism and animism in the belief and customs of Thai people, Buddhism remains the basis in the moulding and development of Thai cultural values. And one cannot understand or appreciate Thai culture 17 _/5 A Cross-Cultural Dialogue on Health Care Ethics without having some basic comprehension of Buddhist tenets. With its holistic worldview, its principle of "dependent origination", and its ideal of compassion, Buddhism has undergirded the Thai cultural understanding of health and approach to health care. Buddhist worldview and dependent origination The Buddhist holistic worldview is primarily based on a belief in the interdependence of all phenomena and a correlation between mutually conditioning causes and effects. This belief is formulated by the principle of dependent origination, also referred to as the law of conditionality, the causal nexus that operates in all phenomena - physical, psychological, and moral. In the physical realm, for example, all things in the universe are intimately interrelated as causes and effects without beginning and end. And the world is an organically structured world where all of its parts are interdependent. Similarly in human society every component is interrelated. The same is also found in the psycho-physical sphere, in which the mind and the body are not separate units but an interdependent part of the overall human system. The Buddhist worldview also comprises a belief in kamma, the correlation between deed and its subsequent consequences, as in the moral realm this principle of dependent origination operates by the name of the law of kamma stating the conditionality of this causal relation.1 This implies that the Buddhist law of kamma does not entail complete determinism. If such a determinism were accepted there would be no possibility of the eradication of suffering. A man would ever be bad for it is his kamma to be bad. But this is not so and the effect of kamma can be mitigated not only in one life but even beyond, as according to Buddhism life is not limited to a single, individual existence. Present life is only a part of the round of existence (samsara) which stretches out across space and time. A single existence is conditioned by others proceeding it and in turn conditions one or a series of successive existences. Existence is thus at the same time an effect in one respect and a cause in another. This imprisonment in the round of existence is the result of one's own deeds (kamma), good or bad. Conditioned by deeds, the present form of existence can be changed or dissolved by deeds. This is possible because the present is not the total effect of the past. It is simultaneously cause and effect. As an effect, we are conditioned by the causal matrix made up of the social and biological continuities of life themselves and thus are the effect of our past deed. What we are now is the result of what we have been before. But as a cause, we are the absolute master of our destiny. The present, though elusive, is the building block of the future. What we shall be depends on what we are and shall do, with our own choice. Buddhism, Health, Disease, and Thai Culture 19 Dependent origination, health, and kamma Within this worldview, health and disease involve the overall state of a human being and are interwoven with many factors such as economics, education, social and cultural milieu...