6 BUDDHIST PERSPECTIVE OF BIOETHICAL ISSUES: THE SOCIAL CONCERN

Thứ năm - 09/05/2019 12:27
by Krishna M. Kamble




 
BUDDHIST PERSPECTIVE OF BIOETHICAL ISSUES: THE SOCIAL CONCERN

by Krishna M. Kamble*






ABSTRACT

The Progress in Science and Technology has definitely helped man to get physical comfort but at the same time greed, hatred and delusionmadehimtolosemoralvaluesandadoptunethicalpractices in almost all spheres of life. Medical field is not an exception; on the contrary since medical science deals with human beings it needs an extra caution in its practice. Major unethical practices in medicine are in diagnosis, treatment, research and education. Buddhism is concerned with relieving the human suffering and so the medical science.

The morality or ethics is the core of both Buddhism and Medical Science. Rapid progresses in Medical technology lead to challenges the way medicine is being practiced today. The need to introduce medical ethics was felt as a result of International Bioethics Survey conducted in 1993 in ten countries of Asia Pacific region by International Bioethics Committee (IBC) under UNESCO. Many people perceived the benefits as well as risk from advancement in Science and Technology.

Bioethics includes medical ethics, environmental ethics, animal ethics as well as issues raised by science technology. The four major




*. Professor, Radiation Oncology, Govt. Medical College & Hospital, Nagpur 440003, India. Research Scholar, International Centre for Buddhist Studies, Rashtra Sant Tukdoji Maharaj Nagpur University, Nagpur, India 440003.
 


bioethical principles are (i) Autonomy (ii) Non-maleficence- No harm (iii) Beneficence and (iv) Justice.

The present paper deals with few bioethical issues through the Buddhist perspective and their social concern like (i) Assisted reproduction or in vitro fertilization (IVF) (ii) Contraception (iii) Abortion or termination of pregnancy (iv) Cloning (v) euthanasia
(vi) Organ donation (v) Animal experimentation etc.

The four noble truths and noble eightfold path of Buddhism gives the insight and remedy to human suffering. The Five precepts and Ten Virtues actions along with Paramitas, Ahimsa, Compassion and Upaya kausalya makes the man perfect in ethical values to relieve the human suffering. Ethics is the core of Buddhism. It views any issue scientifically as explained in Kalama Sutta. It definitely solve the issues raised due to advancement of medical science and technology which will be helpful in balancing the benefits and choices of decision focusing on the human dignity and human rights.
  1. INTRODUCTION

Man desires happiness and peace in life. He relates happiness to physical comfort, which he considers can be purchased with money. To get money he undertakes all sorts of unethical practices like corruption, lying, stealing, adultery, drug abuse and even murdering. Today these things are so common that it became the lifestyle for few people. Even medical profession which is considered the most noble is not an exception. Medicine is the discipline of science, while Buddhism is a philosophy, sometimes considered as a religion. Medical Science is concerned with relieving of human suffering, so it is expected that professionals must follow the ethical principles. The goal of Buddhism is also the freedom from sorrow and suffering of human being. Morality is the core of Buddhism. Thus medical Science and Buddhism are same in their aim and essentiality of ethical values for the betterment of human beings.

Ethics is a branch of philosophy, the discipline that serves to differentiate between right and wrong conduct. Its application relates to different aspects of daily life and acts as a mechanism of judging whether an act is acceptable or not. Medical ethics is
 


supposed to enable us to differentiate good health care practice from bad, as well as to evaluate the merits of medical procedure, such as in resolving the issue pertaining to the action of forgoing life support in terminally ill patient.

Ethicsistheconceptofbalancingbetweenthebenefitsandchoices of decision. Bioethics includes Medical ethics, Environmental ethics and issues raised by Science and Technology. The focus of bioethics is on issues of human dignity and internationally acceptable principles of human rights. Rapid progress of medical technology has lead to challenges, the way medicine is being practiced today. The International bioethics survey conducted in 1993 in 10 countries in the Asia Pacific region, where many people perceived benefits as well as risk from Science and Technology. Thus International bioethics committee was established in 1993.

The worlds major population live in Asia also the worlds popular religions originated in Asia. Buddhism originated in India about 6thcentury BC. Some prefer to call teaching of the Buddha a religion; others call it a philosophy, still other think of it as both religion and philosophy. It may however more correct to call it a way of life. Buddhism is nothing more than an ethical code. Far from it is a way of moral, spiritual and intellectual training leading to complete freedom of mind.

Buddha himself called his teaching Dhammavinaya” the doctrine and the discipline. But Buddhism in the strictest sense of the word, cannot be called religion, for it by religion is meant action or conduct indicating belief in, reverence for, and desire to please a divine ruling power; the exercise or practice of rights as observance implying this, recognition on the part of man of some higher unseen power as having control of his destiny, and as being entitled to obedience reverence and worship. Buddhism certainly is not such a religion. (Piydassi Thera 1987).
  1. BUDDHISM A PHILOSOPHY?
 
Etymologically philosophy means to     love (German
-philein)    wisdom (Sofia).   In Indian thought philosophy
is  termed  Darshan,  vision  of  truth.  In  brief  the  aim  of
philosophy shall be to find out the ultimate truth.
 


Buddhism also advocates the search for truth. The Buddha emphasizes the practical aspect of his teaching. The application of knowledge to life, looking into life and not merely at it. For the Buddha the entire teaching is just the understanding of unsatisfactory nature of all phenomenal existence and the cultivation of the path, leading away from this unsatisfactoriness. This is his philosophy. (Piydassi Thera1956).
  1. UNETHICAL PRACTICES IN MEDICAL FIELD

Today medical science is driven by technology and Pharmaceuticals. It lures the professional leading to unethical practices. There are numerous unethical practices documented amongst health professionals, enumerated by the Union of International Association (UIA), a research institute and documentation Centre based in Brussels, established by Henri la Fontaine (Nobel Peace Prize Laureate of 1913.) are as follows:
    1. Unauthorised medical practice
    2. Unethical behaviour and practice of health professionals
    3. Unnecessary prescribing medical tests
    4. Unethical practices in psychotherapy and radiology
    5. Unethical Pharmaceutical practices: abuse of drug prescription.
    6. Unethical practices in medical research
    7. Financial  exploitation

All these practices lead to erosion of trust between doctor and patient resulting in increased litigations and ultimately loss of harmony, peace and happiness amongst individuals and the society.
  1. CAUSES OF UNETHICAL PRACTICES

If we try to analyse the causes of these unethical medical practices it appears that there is a great craving for money, wealth, name and fame by which people consider they can get peace and happiness in life, but they themselves became the cause for unhappiness and loss of peace in life. As per Buddhist philosophy for every effect there must be the cause. Nothing happens without cause and reason. This causal nexus which is found everywhere in experience is called by
 


technical name in the Buddha Dhamma as “Pratitya Samutpada. So if we consider achieving peace and happiness through earning illegally or by any means it will cause further sorrow and sufferings.

In Buddhism the word “Dukkhasorrow and suffering is used in psychological, physical and philosophical sense. (Piyadassi Thera 1987). So as per four noble truths the selfish craving tanhais the root cause of Dukkha. Tanhais a Pali word which means thirst, desire, wish, longing, greed either physical or mental.

The Buddha identified selfish craving (tanha) the cause of suffering. Self is the cause for sorrow and misery. To annihilate self Trishnamust be suppressed which can be done by continued avoidance of all evil and the doing of good. So in general Buddhism explains the causes of suffering. However the Buddha also identify the “Raga,Dosa(dwesha) and “Moha” as the causes of sufferings.

According to Buddhism there are 10 transgressions acts. They are three of body- murder, theft and adultery, four of speech that is lying, slander and idle talk, and three of mind that is covetousness, hatred and error. All the previously mentioned unethical practices can be grouped in to above ten transgressions. So Buddha prohibited 10 things from being committed as follow (i) Killing a living being.
(ii) Stealing. (iii) Committing adultery. (iv) Lying. (v) Slandering.
(vi) Abusive language. (vii) Frivolous talk. (viii) Avarice. (ix) Evil
intent. (x) False view.
  1. BUDDHIST  ETHICS

The word ethics is not found in early Indian Buddhist text. The discipline of Buddhist ethics developed in west in 1964, when Winston King referred it in his book ‘In the hope of Nibbana. The focus on Buddhist ethics started in 1970 by Srilankan scholar Jayatilleke and Premaisiri. The first journal devoted to Buddhist ethics was published in 1994 by Damian Keown and Charles Prebish. (Keown Damien -2005)

Buddhism has social  dimension  i.e.  wellbeing  and  happiness of the  mankind  as  a  whole.  “Bahujanhitaya:  Bahujansukhay.  It is considered to be supreme. The Buddhist ethics therefore has a close connection with the social philosophy as well, thus it forms
 


an ideal social order. The ethics and social philosophy of Buddhism try to answer what we should not do and what we should do.It is summed up in the stanza Sabbapapassa Akranag, kusalassa upasmpada, sachitta paryodapanang, etangbuddhan sasanang. Not to do any evil, to cultivate the good and to purify ones mind. This is the teaching of the Buddha.

Buddhist morality consists of two things 1. Precepts and 2. Virtues. Precepts lead to concentration, and concentration leads to insight. Thus precepts are fundamentally the discipline of mind and mindfulness. (Thich Nhat Hanh, 2017) Sila means the practice of being awake, or mindful, during each bodily, verbal and mental activity. The precepts are the things a virtuous person would never do. In Buddhism ethical principles are duties rather than rights. They are voluntary commitments. They are to be undertaken by the person committing to Buddhism as under:
I undertake the percept of (training rule) to refrain (abstain) from:
  1. On sought on breathing being
  2. Taking what has not been given.
  3. Misconduct concerning senses pleasure.
  4. False speech.
  5. Taking intoxicants.

In Buddhism these five precepts are the fundamental virtues (Sila) to be observed by upasaka, upasika, novice as well as bhikkhus and bikkhunis. They are the concepts of right leaving. Even though they have the negative expression as they have been expressed in negative wording actually they have positive counterpart as below.
  1. Kindness and Compassion - So as to be trembling for the welfare of others.
 
  1. Generosity and Renunciation- Greed is unwholesome, while generosity is wholesome and much praised.
 
  1. Joyous satisfaction with ones own wife- Contentments and fewness of wishes, contentment is greatest wealth.
  2. Being honest, trustworthy and dependable- Bonds
 


man to truth, recognises falsity and attains precision of thoughts.
  1. Mindfulness and Awareness.
 
  1. BUDDHIST PERSPECTIVES OF BIOETHICAL PRINCIPLES

The four universal bioethical principles 1. Autonomy 2. Non maleficence 3. Beneficence and 4. Justice are developed by Tom Beauchamp and James Childress. These are also analysed from the Buddhist perspective as follows.
    1. Autonomy

Autonomy’ means self rule. It is the notion of human rationality and domination over the body and self. The synonym self determination” highlights the will power as key to autonomy. The personal autonomy embodies three fundamental elements of human dignity. 1) Self control (domination).2) Human rationality and 3) Personal free will. For example: where people choose non personal values such as religious devotion against personal objectives of good health like, i) frail person undertaking difficult pilgrimage and fast or donation of kidney. ii)Diabetic Muslim insisting on undertaking fast in Ramzan or aging athlete tries to run one marathon .(DSouza Russell 2015).

Buddha encouraged his disciple to cultivate self reliance thus: You are your own refuge, who else could refuse be? (Dhammapada 160). Thera Piydassi explained the importance of self determination as “None can grant deliverance to another who merely begs for it. Others may lend us a helping hand indirectly; but nevertheless the highest freedom is attained only through self realisation and self awakening to truth. Self realisation can come only to one, who is free to think out his own problems without let or hindrance. Each individual should make the appropriate effort and break the shackles of existence by perseverance, self exertion and insight and not. Through prayers and petitions to Supreme Being (Piydassi Thera 1987).
    1. Non – maleficence: Do no harm
In Bioethics the concept of non-maleficence, is embodied by
 


the phrase first do no harm. It is more important not to harm patients than to do them good. It happens many times that many enthusiastic practitioners are prone using treatment that they believe will do good, ultimately saying the treatment was a success but patient died. Instead of knowing what good will be done by the treatment it is important to know what likely it will harm the patient, likely benefit should outweigh the likely risk.

However, the principles of non maleficence are not obsolete. It balances against the principles of beneficence (doing well). The effect of two principles together gives double effects i.e. two types of consequences are produced by single action e.g. Use of morphine in dying patients. It has beneficial effect of easing the pain and suffering of the patient. But simultaneously having maleficent effect of shortening the life of the patient through suppression of respiratory system. (Medical ethics Wikipedia)

Buddhism sanctions strongly the act of killing animal whatsoever from the meanest worm up to man. It stresses to have regard for all life. According to Dhammaika Sutta a man should not destroy or cause to be destroyed any life at all. Let him refrain even from hurting any creature, both those strong, and those that tremble in the world. (Dhammika sutta) (Narasu P.1993)

Even the chullavagga explain the mode of no harm, Suffuse the world with friendliness; let all creatures both strong and weak, see nothing that will bode them harm and they will learn the ways of peace.(Narasu P.1993)
    1. Beneficence

‘Beneficencerefers to an action that promotes the well-being of others (the patient).This principal emphasize the moral importance of doing good to others. It entails doing what is best for the patient? This also raises the question that who should be the judge of what is best for the patient? It is often interpreted as focusing on what an objective assessment by relevant health professional in the best interest of patient. However patients own views are captured by the principle of respect for patients autonomy (Hope Tony 2004).

Regarding Beneficence in Buddhism,  Buddhist  regards  it  as his duty to care for the well-being of all animals. It is clear from
 


the second edict of Asoka which says. Everyone in the dominions of his majesty King Priyadarsin and likewise in the neighbouring realms, everywhere on behalf of his Majesty king Priyadarsin have two kinds of hospitals has been established, hospitals for men and hospitals for beasts. Healing herbs, medicinal for men and medicinal for beasts, where they were lacking have every where been imported and planted. On the road trees have been planted and wells have been dug for the use of men and beast. Everywhere in Buddhist countries is the love of animals widely spread (Narasu P 1993).
    1. Justice

Justice’ Addresses what entitlement is due to individuals for their health care. The right of individuals to fair and equitable distributions of benefits and risks or burden of available health care (distributive justice). Particularly regarding womans sexual and reproductive rights as they are often shut out of access due to economic, social or political disadvantage and exclusions. Justice raises questions about how we distribute scare resources. Justice asks of the decision maker might be compromised by a conflict of interest for instance by cultural, religious or other benefits that do not allow lawful medical means of best serving womens need. (Dsuza Russel 2015).

While explaining the concept of Justice in Buddhism P.Narasu explains that, man demands that he should be respected and his right should be protected by lawful means So “Do unto others what you wish they should do unto you, that is to say render to each one that which is his due.Justice should be supplemented by equity and magnanimity. Equity demands that we should resign claims and acts to which we have questionable theoretical rights, so that the advancement of our interest may not cause relatively greater damage to those of others. Magnanimity requires us to overlook personal injuries and not to embrace the opportunity of revenge, though it presents itself. (Narasu P 1993)

It is said that the whole teaching of the Buddha can be summed up in the single verse i.e. “Not to do any evil, to cultivate what is good, to purify ones mind, this is the teaching of the Buddha.
 


(Dhamappada Verse 183). The four principles of bioethics which we have discussed can be summarise with this verse as Not to do any evil = non maleficence No harm; to cultivate what is good = beneficence; to purity ones mind = autonomy and justice.

With this background of principles of bioethics in the perspective of the Buddhist philosophy we will discuss some of the controversial issues related to health.
  1. ASSISTED REPRODUCTION; IN-VITRO FERTILIZATION (IVF)

Conception is a normal natural phenomenon. However there are many couples or women who do not conceive in natural way and such women need medical assistance for fertilization or to conceive. This is possible due to scientific development. In In- vitro fertilization eggs are removed from the ovary. They are fertilized by sperm outside the body (vitro). The fertilization takes place in a control environment. The fertilized egg i.e. embryo start developing in the dish itself and then this embryo or fertilized egg is implanted in the uterus, where the development of embryo takes place in a normal way and even delivery take place normally.
    1. Bioethical View

IVF has source of moral, ethical and religious controversy even amongst medical fraternity. Some of the views are:

Unusual high rate of multiple births. For successful In-vitro fertilization many eggs are to be fertilized. So for successful implantation multiple embryos are to be transferred even though single embryo transfer (SET) technique is available today.

Experimentation on unborn and un-conceived. It appears that the procedure is an experimentation on unborn and un-conceived foetus which may be unethical.

Exploitation of desirous and hopeful childless couple.


It is two way sword, on one side probably we are fulfilling the desire of childless couple to have a child but on the other side we are using science to exploit the couple causing physical, emotional, mental, and economical agony.
 
 
    1. Buddhist View

The technique is not acceptable to Buddhism. This is the breach of first precept, because of the destruction of excess embryos (living being) without consent. Buddhism does not allow human subject as an object of research. (Keown Damien) But, if the intention behind IVF is not to do any evil, but to do good, and all the things are done with the pure mind, no embryo is being wasted, and if the scientific development is in the interest of human being and society it should be acceptable to Buddhism.
  1. CONTRACEPTION

Contraception is a method or device used to prevent pregnancy. It keeps the egg and sperm apart or by preventing the fertilized embryo from getting implanted in the womb.
    1. Bioethical View

Autonomy of a person is important and person must be allowed to make his/her own decision, for which providing information about a) Reliability of the procedure b) potential side-effects c) health risks and confidentiality is important. It is patients right to know and duty of health worker to inform person.
    1. Buddhist View

There is no established doctrine about contraception in Buddhism. Buddhism does not regard to have children a religious duty. Buddhism preaches the importance to take care of children and bringing them up with good quality of life. The methods preventing implantation of fertilized egg by IUD is not acceptable as it harms the life which already became embodied. However contraception methods which do not kill the fertilized egg are allowed in Buddhism.
  1. ABORTION/TERMINATION OF PREGNANCY

Abortion is the ending or terminating the pregnancy by removing the foetus or embryo before it can survive outside the uterus. Induced abortion kills the foetus. Abortions are carried out legally as well as illegally. The reasons may be pregnancy in unwedded mother, female foeticide of unwanted female child
 


(especially in India). In India abortions are legal till 20th weeks in under specific conditions.
    1. Bioethical View

Abortion essentially is a moral issue concerning the commencement of human personhood. The two views are Prochoice- Right of woman about decision to terminate pregnancy. Prolife- Rights of an embryo as foetus to gestate to term and be born.
Few ethical questions about abortion are:
      1. Whether woman has an absolute right to choose what happens in and to her body?
 
      1. Whether continuation of pregnancy would pose threat to life of pregnant women?
 
      1. Is embryo, zygote or foetus a person entitled ethical, legal and moral protection?
 
      1. If they are not a person at conception, at what point in the development process the personhood is bestowed?
 
      1. If they are not a person, is abortion acceptable in case of rape, incest or failure of contraception.
 
      1. If they are a person, is abortion acceptable before viability, that is when they could not survive outside the womb.
 
    1. Argument against Abortion
 
      1. Killing people is wrong - Human life begins at conception; therefore foetus is an innocent human being. Foetus is also a potential being, therefore killing innocent and potential human being is wrong, hence abortion in wrong.
 
      1. Increasing tolerance of killing is wrong - Allowing abortion is legalizing killing. It reduces the respect for life which in a bad thing. It may lead to euthanasia, genocide and increased murder rates. Hence abortion is always wrong.
 
    1. Argument in favour of abortion (in selected cases)
 
      1. The foetus is not necessarily a person with right to leave: A collection  of  human  cells  does  not  have  the  right  to
 


live just because, it is of human species. Otherwise amputating a limb would be a murder. The collection of human cells only have right to live by virtue of certain facts that either, it has reached a particular stage of development that make it a moral person or it possesses certain properties that makes a moral person.
      1. It is not always wrong to end the life of an innocent person: There are many cases where we have to choose which of two innocent people will live and which will die. a) Conjoined twins ,where surgery to separate them may cause one to die. b) In mountaineering when one person can only save his own life by cutting the rope supporting a fallen colleague. c) The women who has to abandon one of her child to save the other.
 
      1. Potential human being has no right, only actual human being has right.
      2. The pregnant women too have moral rights, which include:
        1. The right of ownership of her body, b) The right to
decide own future. c) The right to take decision without
moral or legal intervention by others. d) The pregnant
women have right to life, where not aborting the foetus
would put the mothers life or health in danger. She has
the moral right to abort foetus.
    1. Buddhist View

Abortion has to be explained in the background of Buddhist ethical teaching of Ahimsa. To explain it, one has to answer the question – when does the life begin?” As per Majjim Nikaya, The Buddha divided child birth into four stages: 1) Fertile period. 2) Pregnancy. 3) Birth and 4) Nursing. He explained the conception as a natural process that occurs when specific conditions are fulfilled. The spiritual and material components which constitutes the new individual is known as nama- rupa (mind and matter) and is evolved together from the conception onwards (Homer, Majjim Nikaya). So the modern science and traditional Buddhist teaching considers that the human life commences from fertilization. Thus abortion is contrary to first percept of Buddhist five precepts.
 
 
  1. CLONING

A cloneis a genetic duplicate - a kind of photocopy of another individual. The word clone is derived from the Greek-Klon- meaning a twig. The idea of cloning resembles the way horticulturist takes cuttings from the mature plant and grows them into identical copies of their parents. Cloning in human being replaces the normal process of sexual intercourse. Instead of ovum being fertilized by a sperm, the nucleus of unfertilized ovum is removed and replaced with the nucleus of a somatic (body) cell from a donor. (Skin cell is typically used for this purpose). The ovum is then stimulated and cell begins to divide and reduplicate in normal embryo. The developing embryo is placed in womb and develops into an individual with the same genetic makeup as the cell nucleus of the donor. In conventional reproduction each parent contributes 23 of 46 chromosomes which determine the childs genetic identity. However in a cloned child all the 46 chromosome are identical from single DNA source.
    1. Bioethical View

Many moral and ethical questions were raised with the birth of “Dolly” the cloned sheep in 1997. These experiments were condemned by the religious as well as political authorities and were made illegal in France, Germany, Japan and Australia by an act (2000), while it was banned in USA by in an act (2001). It was considered against the God, as creator of life is only the act of God.
    1. Buddhist View

Buddhists do not believe in Supreme being. There is no divine creator. So that technique of cloning needs not to be seen as an improper or immoral. Cloning is just another way of creating life. However cloning for experimental purpose may have strong reservation as it is against the principle of Ahimsa. Buddhism does not sanction experiment of destroying one life to save another. So Buddhism is sceptical about cloning and its use for the welfare of human being at the cost of destroying life. (Keown Damien 2005).
  1. EUTHANASIA
The   word   ‘Euthanasia’   derived   from   the   Greek   word   -
 


euthanotos- means good, gentle and easy death, especially in case of incurable and painful diseases. Ideally nobody prefer to die in a drugged, unconscious state, rather everybody prefers to die in calm state, free from agitation, anger, denial, joyfully recollecting previous good deeds rather tharegretting ones actions. Active euthanasia is intentionally hastening death by deliberate positive act such as giving lethal injection. While passive euthanasia is intentionally causing death by deliberate omission such as withdrawing food, intravenously administrating nourishments, withholding or withdrawing medical treatment, which would otherwise have delayed death.
    1. Bioethical View
Number of issues are raised against and in favour of euthanasia
1) Is it ever right to end the life of a terminally ill patient who is
undergoing severe pain and suffering. 2) Under what circumstances
euthanasia can be justifiable if at all. 3) Is there moral difference
between killing someone and letting him die?

To answer above Questions we have to answer a) Meaning and value of human existence.
        1. Whether human have the right to decide on the issue of life and death. c) Arguments on practical issues.
 
    1. Buddhist View

From the Buddhist point, the intention of euthanasia from the moral point is considered. The Buddha condemned praising or assisting suicide and with this view to cause death even after request is equal to murder. Thus the act of euthanasia is the breach of first percept. So euthanasia, even after living will is considered as a breach of first percept.

Active euthanasia in case of intense pain can be argued on the basis of compassion, as an acceptable act, but from the Buddhist Vinaya rule even out of compassion praise for the beauty of death is an offence. There are four examples of euthanasia from the Buddhist ethical point of view. 1) A monk urges a monk with intense pain to die to gain a good rebirth as the result of his virtues, so the monk stopped eating and he died. 2) Executioner kills a
 


condemned man so as not to prolong his pain and miserable period of waiting. 3)A man whose hands and feet have been cut off and the relative looking after him want him to die. 4) As agreed, a monk can prescribe the feeding of buttermilk which causes mans death. In all these examples, compassion is the motive still the action can be condemned.
  1. ORGAN  DONATION

It is donation of bioethical tissue or an organ of human body from living (Brain Death) or dead person (Cardiac death) to a living recipient in need of transplantation.
    1. Brain death v/s cardiac death

Brain death is a condition where brain is irreversibly damaged but whose heart is beating and circulation is intact where the vital functions are maintained may be artificially by ventilator or so. In such condition the patient is considered as legally dead, if patient is certified by two independent physicians apart from caretaker physician after the prescribed tests carried out for detecting brain death. In such condition the organ can be retrieved and can be transplanted. The other condition where heart is stopped and patient is declared physically dead, few organs can be removed and transplanted. Such transplant is known as cadaveric transplant. However most of the organ transplants are being done out of the brain dead patients.
    1. Bioethical View

Most important ethical issue in organ donation is patients au- tonomy, living will and guardianship. The major debate is over 1) Whether or not a brain dead patient ought to be kept artificially animate in order to preserve organs for procurement, and 2) Black marketing of the organs. Those afford black market organs are typi- cally weloff, which is unethical.
    1. Buddhist View

In Buddhism death is considered as essential part of human predicament. Buddhism defines death in terms of the concept of impermanence (anicca) and insubstantiality (anatta). Total
 


dissolution of five aggregates in the individual is seen as death. The ceasing of the functioning of higher cortex does not constitute death in Buddhism. Thus the concept of brain death is not accepted as death in Buddhism. So Buddhism provides protection against premature removal of organs. (Ratnakul Pinit 2004) However some Buddhist have defended organ transplantation on the ground that it is the final compassionate act(le CSO 1991) and even means to acquire merit for a better rebirth.(Honglonandarom.S2006)
  1. ANIMAL   EXPERIMENTATION

In animal experimentation live animal is forced to undergo something that is likely to cause the pain, suffering, distress or lasting harm. Millions of animals suffer and die in testing and other experiments in cruel, chemical, drug, food and cosmetics tests as well as in medical training.
    1. Bioethical View

Animals have moral rights (animal rights), so people are against the animal experimentation as there is no moral justification to any harmful research on animals that is no benefit to the individual animal.
    1. Buddhist View

Buddhists have to practice love and kindness towards every living being. Every living being has right to exist. Animals also have fear and pain as do human beings. Animals need our sympathy. The Buddha was very clear in his teaching against any kind of cruelty to any living being. Mans cruelty towards animals is expression of his uncontrolled greed. Buddhists middle way allow animal testing only, if it is absolutely necessary and if it definitely show that research would serve human being. Animals should be kept in human condition and not to be tortured under any circumstances. (Snydes David 2006)

Animal experimentation for scientific research is known. The practice of vivisection has been symbolized to undue cruelty and no regard to animal suffering. Buddhism describes compassion and nonviolence. Thus painful and cruel animal experimentation is not acceptable to Buddhism. However it appears that causing
 


sufferings of animals for human gain is permissible particularly if the experiments do not cause pain. (Keown Damian 2005)
  1. TEACHING BIOETHICS

Medical code of ethics is considered to be far more stringent than the law. The code reinforces that the primary goal of the medical profession is to render service to humanity.While emphasizing that rewards or financial gain is a subordinate consideration and under no circumstances may physician place their own financial interest about the Welfare of their patients.

American Medical Association (AMA) has served ethical guidelines since mid 1840. UNESCO initiated the ethics education in 2004. Currently there are more than 114 bioethics chair Haifa units all over the world from Armenia to the USA to Vietnam. There is a newsletter (bioethical voices) and a free journal with editorial board in Sri Lanka. (Deshpande Smita).

The rules of medicine are mandatory - so they have to be taught in medical curriculum. The education of ethics enables us to differentiate good health from bad as well as to evaluate the merits of medical procedures. As the time is passing medical ethics becoming more complex and it is no longer for physicians to simply treat patients as they would wish to be treated.

Role models are known to shape the values, attitude, behaviour and ethics of medical trainees. Hence to develop ethical training in leading hospitals, clinical teachers would have to play a major role. (Kalantri S P2003).

Training Of medical ethics is a continuous process. It requires reinforcing during specialty training also. The main motivation for such training is to focus and train new academicians. Today ethical issues have become complex, profound and require careful investigations to find right answers. When medical ethics is taught by clinicians, it has an advantage because they use clinical language which is readily acceptable by the students.

An international survey conducted by medical ethics curricula in Asia by Mahaskaetal (China, Hong Kong, Taiwan, Korea, Mongolia, Philippines, Thailand, Malaysia Singapore,, Indonesia,
 


Sri Lanka, Australia and New Zealand) showed total 89 medical schools offering some courses in which ethical courses were taught.(Miyasaka  m.  akabayashiA,KaiI,OhiG.1999).
  1. LEARNING BUDDHIST ETHICS

What man differs from other animals is his possession of certain intellectual and ethical powers. Only by the harmonious and perfect development of these powers can each one of us truly realize his humanity and make himself serviceable to his fellows. As per Bodhicharyavarta in Buddhism there is no real mortality without knowledge, no real knowledge without mortality, and both are bound up together like heat and light in the flame.

Bodhi is not mere intellectual enlightment, but intellectual enlightment combined with compassion for all humanity. The consciousness of moral excellence is of very essence of Bodhi. Buddhism does not teach that man is by nature evil. The evil in man is not inborn; naturally they are good. Hence for its moral percepts the Dhamma seeks no external source of authority. Buddhists do not regard various moral percepts as Commandments by the Buddha. Every Buddhist takes as his model perfection. There is no reward or punishment in Buddhism in future world, yet there is law of cause and effect whose say in the domain of ethics is as powerful as in the domain of Physics.

The Buddhist ethics is purely autonomous. Buddhism is religion or philosophy for incorporating in the practice. The ethical principles are to be imbibed into the society. They may not be taught in the conventional schools and colleges but through monks to lay followers in the society.
  1. CONCLUSIONS

As reminded by American Medical Association in 1995 that physicians, as physicians, are not, and must never be commercial entrepreneurs, gate closers or agents of fiscal policy that runs counter to our trust. As well as the Council of Medical specialty societies published their consensus statement in 1997 reminding physicians that the practice of medicine is rooted in a covenant of trust among patients, physicians and society. The
 


Ethic collective obligation to all who need medical care. (Dyes Kirsti 2001)

It is an expectation that teaching medical ethics curricula in our medical schools will produce better young doctors who will be good managers of healthcare resources, advocates for patients and maybe leaders for organizational change. Ethical issues are being faced commonly by residents and physicians and they may experience difficulty in understanding and managing these dilemmas. The well constructed courses in medical ethics for undergraduates and young doctors are needed to provide array of completeness in dealing with ethical dilemmas. (Gondal Ghulam Murtaza 2004)

It appears that the people following Buddhism tend to follow ethics in medicines more easily as to accept medical ethics after accepting the Buddhism is more \ easy. That means the people following Buddhism can be moulded easily and the modern bioethical principles can be more easily adopted by Buddhists, rather it becomes the way of their life. So propagation of and adopting Buddhism may help to establish ethical society.

The secret of Buddhism is, to be awake here and now. There is no way to peace; peace is the way. There is no way to enlightment; enlightment is the way. There is no way to liberation; liberation is the way (Thich Nhat Hanh 2017). Buddhism from beginning to end is open to all those who have eyes to see and mind to understand, for freedom of thought it is the birth right of every individual. (Piydassi Thera 1927)









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