EUTHANASIA AND SUICIDE | Zen Wisdom

QUESTION:
Medical advances have made it possible to prolong the lives of the terminally ill, sometimes well beyond the point where there is any hope for recovery. People have been kept alive by medical technology even though patients sometimes express a wish to die. This has become one of the more complex moral and legal questions of our time. What do you think is the correct view for Buddhist practitioners to take on this question?

SHIH-FU:
We need to distinguish two cases. The first one occurs when the patient’s vital functions are gone. This person would have no sensation or feeling, and in effect is clinically brain-dead. This person can only be kept alive intravenously, possibly with life support-devices. It is not wrong to terminate life support for such a person, but there should be no active intervention, such as lethal injections, to hasten the end. We must still observe the precept against killing. Let nature take its course.

The other case consists of patients who, though terminally ill and suffering, have feelings and thoughts. These patients should not be allowed to die even if they express the wish to do so. The reason is that they still have time remaining in their lives for religious practice. For example, they can recite the Buddha’s name, pray, meditate, or do other spiritual practices. The idea is that one should use every possible opportunity to practice, to aim for a better rebirth, to put one’s karmic house in order before dying.

People who want to die are perhaps in great pain and want to get it over with. If medicine can help with the pain, then it should be used. But even if the medicine is of no use in alleviating pain, then they should make strong resolutions to bear it, recognizing that their situations and pain are the fruits of their karma. Again, they should be exhorted to practice. Others can help them by reciting the Buddha’s name near them, or praying for them.

There are intermediate situations where there is no evidence of feeling or mental activity, but the patient is capable of oral feeding. Almost certainly, there is no karma being created, but if the body indicates it wants to be fed, it should be fed. If not, don’t. There is a case in Taiwan of a girl of sixteen who was hit by a car and is still lying in a hospital bed at the age of forty. There is no response from her, but she is able to eat. So a lot of people say, why don’t we end it for her, just give her a shot? But life is still there, and you can’t terminate it.

Even though it costs a lot of money to keep this woman alive, and it is hard on the family, her life should not be terminated. If the girl still has feeling, she has to reap her bad karma, and so does her family. There is no avoiding karmic retribution, which must be paid. If not in this life, then in another.

STUDENT:
What is the bad consequence of letting her die?

SHIH-FU:
When there is a decision to let her die, to give her a shot, or just pulling the plug on the machine, the bad karma of killing is created.

STUDENT:
So if a practitioner expresses a wish to die, he or she should be reminded that there could be karmic consequences to making that kind of decision?

SHIH-FU:
That’s right

STUDENT:
Relating to suicide, is there any circumstance where taking one’s own life is justified? And legally, what about the question of the right to die? There are those who are very old, feeble, or in so much pain that they want to die, or perhaps they are in a vegetative state. What about the Vietnamese monk who burned himself as a protest against the incursion of communism?

SHIH-FU:
From the perspective of fundamental Buddhism, all of these examples are against the teachings. The principle of karma is that whatever actions people perform, they will incur the appropriate kind of consequences, regardless of whether they are healthy or unhealthy, young or old, useful or useless, aware or unaware. And also, this kind of cause and consequence sometimes does not affect only the people themselves, but also everyone around them.

For example, if a person has an old parent who needs a lot of help or is in great pain, who may be in a vegetative state, the person who must take care of the sick person is also suffering the consequence of previous karma. These things do not affect only the individual but also the people concerned, so we cannot say, “Oh, just because this person is in serious
pain or causing other people to suffer, we will just eliminate him.” That would not be right.

In the teachings of Bodhidharma there is an article called The Four Practices to Enter the Path. First is the practice of paying back one’s debt The second is practice in accordance with conditions. Third is the practice of not seeking anything. Fourth is practice in accordance with dharmas. This fourth one means to deal with each dharma as it is. So, if people are suffering, we should try to help them. We should use modern medicine if it is available. But if we cannot help them, then their suffering is also dharma, so we should deal with the suffering as it is. One cannot arbitrarily kill oneself or others, regardless of the conditions, or state of awareness. Once we take a life, we violate the basic principle of Buddhadharma. As to the Vietnamese monk, that is also not acceptable. Sakyamuni never taught his disciples to burn themselves in order to save their own country. What a waste.

During Sakyamuni’s time, there was a group of people who attained arhatship. Some of them had the peculiar idea that since they attained arhatship, there was nothing left for them to do. They thought life was useless, and they may as well die. At the same time there were some who felt they were free from vexation, but were afraid the vexations might one day return. So to avoid the trouble they decided to kill themselves. Within a short time many arhats and practitioners who thought they were arhats had killed themselves. When Sakyamuni heard about this, he forbade the practice.

STUDENT:
More on the vegetative state. Now we have the technology to keep people alive when they would normally expire. What about this?

SHIH-FU:
Now that the technology is available, we must use it to do our best to keep these people alive. It goes back to treating each dharma as it is. This is a matter of one’s attitude. If there is no technology available, then there is no issue. When there is a machine available, you have a choice of using or not using it, or disconnecting it. In fact, this is a passive way of helping someone to die.

STUDENT:
If a law is passed that says under certain conditions we can perform euthanasia, and we follow this law under the prescribed circumstances, what kind of karma is involved?

SHIH-FU:
If laws are passed, or if it is the custom of the culture to kill someone who is in extreme suffering, or allow people to die who are in vegetative states, then it depends on whether we have a choice or not. If we have no choice, then karma is still created, but it is collective karma. If the decision is left up to the individual, then it is personal karma.

STUDENT:
I experienced this in my own life. My mother fell into an irreversible coma. Doctors said she would never snap out of it, but they were able to prolong her life indefinitely. The cost was enormous. One day my mother appeared to me in my mind and very clearly told me that she was gone, that she had left the body a long time ago, and that I should let things take their natural course and allow her body to die.

SHIH-FU:
From the point of view of Buddhadharma, we should not put absolute faith in these psychic experiences. Meeting with spirits, with dead relatives, hearing voices, either directly or through a medium, none of these experiences is reliable. I am not saying they are untrue. I am saying they are unreliable. If you believe in this kind of phenomena, then it’s possible you will always be looking for it, will grow attached to it, will depend on it, will depend on seeing the world in this way. Yes, it might be true, but it might also be something that arises from your own consciousness.
On the other hand, such experiences can be considered valuable in a religious sense. We cannot say that Buddhists should not have or do not have such experiences. A lot, in fact, do. But the attitude of Buddhists is that just because they experience something doesn’t mean it is absolutely true.

STUDENT:
Let’s suppose there is a body in an irreversible coma, and the person is deemed to be brain dead; that is, the brain’s higher functions have ceased operating and there is no reasonable likelihood that they will resume operation in the future. All that works is the brain stem which controls life functions. Suppose also there is no supernatural contact with the spirit of the person directing someone to disconnect the machine. In other words, we have only modern medicine and our own judgment to go by. Isn’t it more compassionate to disconnect the machine and let the body do what it would naturally do?

SHIH-FU:
I would ask to whom are you being compassionate? If the person is in a coma, then he or she is not aware of anything. If the self has left the body that is being kept alive, then there is also no issue. That leaves compassion toward the living.

It is not certain in those cases if there is still a self present in the body. It is possible that the self left, that it has even taken a new birth, or that it is still holding onto the body. How can one be certain? Even if a medium tells you the self is gone, how can you be certain the medium is correct? If the spirit of the person tells you directly that the body is lifeless, how can you be certain that it is really and truly the spirit of the person? It could be your imagination. It could be a ghost or deity playing with you. In the end, however, you are left with a decision to make. Buddhism does not dictate what you can and cannot do. It speaks of causes and consequences. You are free to act. If you feel it is in the best interest of everyone to pull the plug and let the body expire, and you follow through on your decision, then there will be consequences for your action. The consequences may be good or bad, light or heavy. In any case, you will not know when the consequence arises, just as you are now living the consequences for things done in the past. Your life now is the consequence of your previous actions. Do you know what your present consequences derive from? What you do now will sow the seeds for future consequences. There is no merit counter in the sky who is judging you, who is going to forgive you or punish you. It’s your move.

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