BUDDHISM, BIOETHICS IN

Buddhism originated in India around 500 b.c.e. In the early twenty-first century Buddhist traditions exist in South, Southeast, and East Asia, as well as Australia, Western and Eastern Europe, and North and South America. The diversity found in these traditions makes it impossible to speak of Buddhism in the singular or to assert an "official" Buddhist perspective. For the purpose of formulating an overview of Buddhist bioethics, however, Buddhist traditions can be categorized into two primary trajectories: Theravada and Mahayana. Theravada traditions are closely identified with the teachings of the historical Buddha, and include both early South Asian Buddhist traditions as well as contemporary South Asian traditions in Sri Lanka, Thailand, and Myanmar (formerly Burma). Mahayana traditions include some later forms of Indian Buddhism, Tibetan and other Himalayan-region Buddhisms (also referred to as Tibetan, Vajrayana, Tantric, and Esoteric Buddhism), and Central and East Asian Buddhist traditions. Both Theravada and Mahayana Buddhism are practiced in such places as Australia, Europe, and North and South America.

Historically, bioethics has been a field of inquiry primarily in Western cultures and thus centers on Western cultural assumptions and moral perspectives. Genetic engineering, cloning, and stem cell research—and the ethical dilemmas they engender—pivot on recent advances in biomedical technology and Western emphases on the value of medical progress. However, moral issues raised by biomedical technology are no longer confined to Western cultural contexts. Predominately Buddhist countries have begun to confront the ethical implications of biomedicine. Not surprisingly, Buddhist ethical perspectives stem from assumptions that are sometimes very different from Western views, and these concerns affect how Buddhists engage with bioethical issues.

Individuals from North American and European cultural backgrounds may be troubled at the specter of "playing God" in making ethical decisions. From a Buddhist perspective, however, emphasis is placed, for instance, on investigating how the Buddha's exemplary life and compassion might reveal satisfying solutions to problems never envisioned by past Buddhists. After outlining some fundamental Theravada and Mahayana Buddhist ideas, this entry considers ways that Buddhists might respond to bioethical dilemmas and which Buddhist religious ideas could be invoked to make sense of diverse bioethical issues.

Theravada Buddhist Thought and Practice

Western interpretations of the Buddhist Dharma—Buddha's law or teaching—often treat it as a philosophy. Although it is possible to view the Dharma this way, Buddha emphasized the centrality of religious practice over philosophy and doctrines. Intellectual understandings merely point at what must ultimately be realized through experience. Buddha posited a religious path attainable through a rigorous tripartite practice of wisdom, morality, and meditation. These three were the foundations of the Noble Eightfold Path, Buddha's outline for how to live the religious life.

Theravada Buddhism focuses particular attention on the life of the historical Buddha (c. 563–483 b.c.e.). Buddha ("The Enlightened One") was a human being who, through assiduous spiritual practices, was able to comprehend the true nature of the universe. The realization of this transcendent wisdom is the achievement of nirvana, or enlightenment. Buddha, therefore, is a model for humanity, an example of what is possible by diligent practice of the Dharma.

The biography of the historical Buddha recounts the story of an entitled prince, Siddhartha Gautama of the Sakya clan, who is provided with material comforts and sensual pleasures by the king, his father. Wishing that his son will become a great leader, the king arranges for the prince to be sequestered in the palace, shielded from the pain and suffering that afflicts human beings. Over time, the prince— now grown and married with a young son—becomes curious about the world beyond the confines of the palace. Against his father's wishes, he ventures outside the palace walls on four separate occasions. Each time he encounters an aspect of human experience hitherto unknown to him. The four encounters—a sick person, an elderly person, a corpse, and a religious ascetic—result in the prince's realization of the fundamental suffering of human existence. The encounter with the ascetic prompts Prince Siddhartha's quest to attain an understanding of the world that would end suffering.

Prince Siddhartha subsequently decides to leave the palace and pursue the spiritual life of an ascetic renunciant. Single-minded in his resolve to attain spiritual liberation from the bonds of human existence by denying material needs, he nearly starves to death. As a result, he recognizes that liberation must lie somewhere between extreme hedonism and severe asceticism. He embarks on what becomes known as the Middle Path, a practice that allows sufficient bodily nourishment to carry out meditation and other spiritual practices. Through deep and persistent meditation he attains nirvana, thereby becoming Buddha. A reluctant teacher, he eventually accedes to the desire of others that he expound upon what he has learned. Thus begins Buddha's lifelong teaching of the Dharma.

Buddha's teaching centers on wisdom attained through enlightenment, a transcendent awareness of both the problem in the human condition and a means to its solution. This problem finds expression in the Three Marks of Existence, a description of the nature of life within the unenlightened world of samsara (the cycle of birth-deathrebirth). Individual status in the samsaric cycle is determined by actions (karma ) and their moral consequences. Moral behavior leads to a higher spiritual rebirth, while immoral actions result in movement away from enlightenment. Buddha recognized that the samsaric world is fundamentally unsatisfactory and human beings eventually seek escape from it. According to the Three Marks, all existence is characterized by: (1) impermanence (anitya ); (2) suffering (duhkha ); and (3) absence of a permanent ground or essence (anatman ).

Impermanence refers to the idea that all aspects of the samsaric world are in constant flux. While the world might appear to have stability and solidity, deeper scrutiny reveals that samsara is characterized by perpetual instability. Human beings mistake the temporary coming together of constituent elements (dharma s) for permanence. Thus, the world is best characterized not in terms of the atomistic existence of discrete enduring objects, but rather as a state of dependent origination, or interdependence—pratitya-samutpada. Samsaric entities—including human beings—exist as a result of cause and effect. Nothing has an intrinsic foundation or essence that gives rise to its own existence. Samsara itself is understood as constituted by conditioned reality, that is, arising from a series of causes and effects.

The second mark of existence is suffering. The Buddhist term duhkha refers to both physical and mental suffering—especially the latter. Duhkha signifies the anxiety and insecurity prompted by the impermanent, transitory nature of the human condition. Markers of impermanence include the cycle of birth, disease, old age, and death, as well as anticipation of the inevitable loss of happiness and other temporarily pleasant emotions. Buddha did not deny the reality of happiness, but simply noted that it too is fleeting and impermanent. Suffering results from ignorance of the true nature of the samsaric world as transitory, momentary, and subject to constant flux.

The third mark of existence, anatman (no-self), refers to the absence of a permanent self or eternal soul that persists after physical death. Human ignorance engenders a misperception of current identity or sense of self as an enduring, independent essence. This idea is illustrated in an Indian Buddhist text that relates a dialogue between King Milinda and the monk Nagasena. In the Simile of the Chariot, Nagasena asserts that the self, like a chariot, has no essence. The King protests, so Nagasena describes the process of disassembling a chariot. Once the chariot has been reduced to a pile of parts, the King concedes that there is no essence of the chariot that persists. Like the chariot, human beings consist of constituent elements. These elements coalesce to form both animate and inanimate objects. Upon death, the dharma s disperse and re-form due to cause and effect, but no aspect of self, soul, or personality persists. Thus, anatman asserts that all existence is causally conditioned. The five aggregates of dharma s that constitute human beings are constantly arising and ceasing, but they do not produce a discrete, identifiable self or soul.

In accord with the worldview expressed by the Three Marks of Existence, Buddha taught that liberation from suffering may be attained though the Four Noble Truths:

1. All existence is suffering.
2. Suffering is caused by desire.
3. Cessation of desire results in the cessation of suffering.
4. The Eightfold Path leads to liberation (nirvana).

Like a medical analysis of the human condition, the Four Noble Truths mirror the steps of diagnosing a disease (suffering), understanding its cause (desire), identifying the cure for the disease (cessation of desire), and prescribing medicine that effects the cure (Eightfold Path). An outline of attitudes and actions necessary for spiritual advancement and enlightenment, the Eightfold Path offers a foundation for understanding Buddhist ethics in general and Theravada Buddhist bioethics in particular.

Buddha expounded the Eightfold Path as the mental and physical practices necessary to reach liberation from the samsaric world. The Eightfold Path consists of three components: wisdom (prajna ): (1) right views and (2) right intention; morality (sila ): (3) right speech, (4) right conduct, and(5) right livelihood; and concentration (samadhi ): (6) right effort, (7) right mindfulness, and (8) right concentration.

Wisdom refers to the fundamental mental states necessary to practice Buddha's Dharma. Right views include knowledge and acceptance of the Four Noble Truths and other aspects of the Dharma. Right intention refers to cultivating qualities such as compassion, benevolence, and detachment from the fruits of actions, and a commitment to harm no living creatures.

Morality is conceptualized in terms of speech, conduct, and occupation. Right speech requires that Buddhists abstain from verbal abuses such as slander, lying, and gossip.

Right conduct refers to the avoidance of actions that harm others, such as killing, stealing, and sexual impropriety. Right livelihood extends the ideal of moral actions and prohibits specific occupations. Thus, one must refrain from work that leads—either directly or indirectly—to harming other living beings.

Concentration entails mental practices aimed at purifying the mind of evil and other distracting thoughts, and gaining mastery of mental processes and feelings in order to engage in advanced meditation.

The practice of the Eightfold Path is neither linear nor sequential. Rather, all eight aspects must be cultivated simultaneously. Through self-effort these practices eventually effect a spiritual transformation from ignorance to a state of transcendent wisdom—nirvana . One who has cultivated of the Eightfold Path and achieved liberation is known as an arhat (holy one)—the model of Theravada Buddhist religiosity that all endeavor to follow.

Mahayana Buddhist Thought and Practice

Even a brief survey of Mahayana Buddhism, which arose less than 500 years after the historical Buddha's lifetime, strongly suggests that "Buddhist bioethics" cannot be approached in singular terms. Mahayana refashions Theravada perspectives through the concept of sunyata (emptiness), while adding a new soteriological possibility based on faith: birth in a Buddhist paradise as the goal of religious praxis. Thus, Mahayana Buddhism incorporates the ideal of enlightenment achieved through individual self-effort—Zen Buddhism is the most well-known exemplar of this—as well as potential for salvation through birth in a Buddhist paradise. Particularly noteworthy is the Western Paradise, or Pure Land, of Amitabha Buddha who vows to save all sentient beings that call on him for assistance. Further, anyone— monastic or layperson—could practice devotion to the "other power of Amitabha, " emphasizing for the first time nonmonastic practice leading to salvation.

In contrast to Theravada emphasis on the arhat, Mahayana focuses on the figure of the bodhisattva, a concept that has two primary significances. First, meditation-based Mahayana centers on the bodhisattva vow, a pledge to follow the Buddha's Dharma in order to achieve enlightenment and to compassionately assist others in the same quest. Through meditation, the bodhisattva aims to perceive the reality of the universe—that all dharma s are empty of self-nature. The concept of emptiness (sunyata ) asserts that all dualistic perceptions are misperceptions, and that nirvana and samsara are the same thing. Otherwise, a duality or opposition between the enlightened and the unenlightened is being expressed. The Mahayana goal is not to transcend samsara, but rather to understand—experientially—that dualities result from a mistaken view of nirvana as permanent and eternal, existing outside of samsara.

Second, in faith-based Mahayana, the term bodhisattva describes compassionate figures, like Avalokitesvara (Known in China as Guanyin and in Japan as Kannon), who have advanced along the path to enlightenment and gained great spiritual powers. They are called upon for assistance with both spiritual and material difficulties. Faith-based Mahayana recognizes that, for most lay Buddhists, following the Dharma is too difficult. In a degenerate age far removed from the teachings of the historical Buddha, the only hope for release from samsara is by calling—single-mindedly and with devotion—on those whose spiritual progress far exceeds our own. Devotions may be made to Amitabha Buddha for spiritual and material assistance in addition to the intervention of bodhisattva s.

Mahayana conceptions of the bodhisattva critique the Theravada arhat ideal, arguing that in an interdependent world individuals must assume responsibility not only for personal enlightenment, but also for assisting others in the quest. Thus, spiritual compassion becomes significant in Mahayana ethics in general, and in bioethics in particular.

Approaches to Buddhist Bioethics

Buddhist ethical perspectives, unlike some Western views, seldom characterize morality in absolute terms. For Buddhists, ethical behavior is a necessary component of successful adherence to the Dharma rather than an end in itself. Once enlightenment is attained, dualities expressed in ethical problems cease to exist. Action is judged not against an absolute moral standard (such as the Ten Commandments), but rather on the basis of its relative merit in leading toward or away from enlightenment. From an enlightened perspective, actions can no longer be characterized as moral or immoral. Rather, action (karma ) has a neutral value, transcending moral distinctions. As such, ethics are important to the spiritual practice of human beings, but they have no larger significance.

Historically, Buddhist monastics and lay people have expressed ethical concern for the poor, the sick, and the elderly. Yet Buddhists differ in their approaches to bioethical dilemmas. In part, competing bioethical interpretations arise from Theravada and Mahayana distinctions. Further, as Buddhism has traveled across Asia and other parts of the world, diverse indigenous cultural traditions have informed Buddhist notions of morality. The divergent views of Buddhist practitioners and scholars of Buddhism add another dimension to understanding Buddhist bioethics. Finally, interpretive concerns arise when contemporary bioethical problems are evaluated using Buddhist texts composed centuries before the advent of current biomedical technologies. Despite these complexities, concepts such as non-harm (ahimsa ) in Theravada and compassion (karuna ) in Mahayana—though they do not posit an explicit bioethics— offer a way to measure the morality of bioethical issues.

Theravada Buddhist Bioethics

Precepts for both monastics and laypersons provide a starting point for investigating Theravada bioethics. Although the number of precepts and issues addressed differs depending on individual religious status, there is nevertheless a core set of values applied to all Theravada practitioners. Buddha's moral conduct serves as a behavioral model for those who wish to pursue nirvana.

The sangha, or monastic community, is bound by a code of moral conduct inscribed in monastic rules (vinaya ) that were established to promote the rigorous mental and physical discipline required to achieve the Theravada religious goal. These detailed rules regulate monastic life and spiritual practice. The first five of the ten Theravada precepts, which apply to both monastics and laity, are:

1. abstention from causing injury to all living beings;
2. abstention from theft and cheating;
3. abstention from sexual misconduct;
4. abstention from lying and other forms of injurious speech; and
5. abstention from intoxication.

Of these five, injunctions against killing, lying, and sexual misconduct have specific relevance to Theravada bioethics. These precepts carry additional significance when coupled with other Theravada Buddhist concepts. For example, respect for life and non-injury to living beings (ahimsa ) is linked to the idea of pratitya-samutpada , the interdependence of existence and consequentially the moral responsibility of all beings.

As noted above, Theravada Buddhist traditions assert that the universe is fundamentally impermanent. Given this assumption, Theravada ethics strongly advocate comforting the terminally ill rather than trying to extend life through any means available. The value of life is not commensurate with lifespan, and death is understood as an inevitable consequence of unenlightened existence in an ephemeral world. Attempts to postpone death are unnatural acts that suggest a morbid (and ignorant) fear of death and an egomotivated attachment to life.

Theravada principles both inform and complicate responses to contemporary bioethical dilemmas. For example, in Thailand, Theravada Buddhism is intimately connected to all aspects of life. Abortion in Thailand is prohibited by legislation that makes exception only in circumstances such as danger to the mother's life, rape, or incest. Theravada precepts against killing and doing harm to others are used to justify this legislation. Thai Buddhists apply the precepts to the unborn because a fetus is considered a human being from conception, and often cite traditional Theravada texts that oppose abortion.

However, orthodox Buddhist views sometimes clash with the realities of contemporary life in Thailand. In fact, abortions are performed in Thailand (although illegally), and Thais advocate different interpretations of Theravada ethical principles to justify or deny the morality of abortion. While some Buddhists invoke the nonharm precept, others maintain that abortion—in cases such as pregnancy due to rape or incest—can contribute to positive karmic consequence if performed with selfless intention.

On the other hand, in situations where abortions might be morally justified—at least in the United States—this is not necessarily the case in Thailand. Malee Lerdmaleewong and Caroline Francis list reasons that Thais cite for seeking illegal abortions, including economic difficulties and the lack of adequate or effective contraception. Yet, when a Thai woman learns that her fetus is developing abnormally due to Down's syndrome or some other serious disease, abortions are rarely sought (Ratanakul, 1998). In such cases, women are reluctant to seek an abortion because they believe that the fetus's disease is the result of negative karmic consequence produced by both the mother and the fetus (in a prior existence). To abort the fetus would only increase the negative effect. (Ratanakul, 1998). Fear of detrimental karmic consequence, then, is a deterrent to having an abortion.

Mahayana Buddhist Bioethics

Mahayana Buddhist bioethics often center on the ideal of the bodhisattva. In devotional Mahayana, bodhisattvas such as Avalokitesvara embody compassion and the power to save those in material or spiritual distress—thus serving as ethical exemplars. In meditation-based Mahayana, emphasis is often placed on the ethical implications of a bodhisattva 's wisdom and experience of emptiness (sunyata ). Despite positing different ethical ideals, the moral import of compassion and wisdom are interrelated in faith- and meditationbased Mahayana. Wisdom without compassion is no wisdom at all, and compassion without wisdom is potentially dangerous because action might originate in desire and attachment. Realization of compassion and wisdom results from actualizing attitudes and mental conditions—such as generosity, patience, and diligence—that are among the six perfections that bodhisattvas strive to achieve.

In part, the Mahayana bodhisattva ideal resulted in an increased emphasis on both monastic and lay concern for the spiritual and material well-being of others. Bodhisattvas enact the virtues of compassion and wisdom by striving to alleviate suffering and attending to the sick and elderly, among other selfless activities. When bodhisattvas declare the "thought of enlightenment" (bodhicitta ), they vow not only to attain enlightenment, but also pledge to overcome defilements and to utilize compassion and wisdom to save all sentient beings.

For some Mahayana Buddhists, the imperative of compassionate action can override injunctions against harming others, lying, and other apparent violations of Buddhist morality. In essence, precepts may be broken in order to help others. This is possible because of the related notion of upaya —an expedient device. According to this important Mahayana concept, the historical Buddha used expedient means to expound the Dharma. That is, he presented his teachings in accord with variations in individual ability to comprehend his religious message. However, these alternate versions of the Dharma ultimately lead to the same truth. Similarly, bodhisattva s employ efficacious devices according to the needs of those who seek their aid. Japanese stories, for example, recount instances in which bodhisattva s assume the guise of a thief in order to be thrown in jail and thereby gain access to incarcerated individuals in need of spiritual solace. While this expedient device seems to transgress the precepts, the act is justified by virtue of compassion. In this and similar situations, the motivation for a behavior becomes central—a bodhisattva can only perform such actions if detached from any idea of self-benefit. As a being liberated from dualistic distinctions such as good and evil, the bodhisattva demonstrates action informed by the realization of sunyata, and the moral efficacy of integrating compassion and wisdom.

Bodhisattva virtues of compassion and wisdom impact Mahayana perspectives on bioethical issues such as abortion. For instance, in Japan, Buddhists do not officially condone abortion. Nevertheless, Japanese Buddhism generally tolerates abortion and sometimes plays a significant role in assuaging the negative karmic consequence that accrues from abortion.

In Japan, abortion is considered a necessary sorrow (LaFleur, 1990). That is, while never a moral good, sometimes abortion can be justified over carrying a child to term. From a Japanese perspective, it is morally problematic and socially irresponsible to bring more children into the world than a family can support and nurture. In addition, Buddhist beliefs about rebirth characterize abortion as postponing the fetus's entry into the samsaric world. However, there are moral consequences to aborting the fetus. In order to try to rectify the negative karmic consequence that accrues from an abortion, Japanese Buddhist rituals, known as mizuko kuyo, are performed in order to speed the soul of the aborted fetus (mizuko ) to a more positive rebirth. In addition, mizuko kuyo are intended to comfort aborted fetuses. Such rites also serve as a way for parents to repent sexual misconduct that results in unwanted pregnancy. Repentance helps alleviate the effects of immoral behavior, especially when admitted to a Buddha or bodhisattva.

Abortions are a common form of birth control in Japan and temples devoted to mizuko kuyo flourish to meet the spiritual needs of both mother and aborted fetus. The bodhisattva jizo (in sanskrit, Ksitigarbha; literally Earth Womb ) is usually a focus of worship at these temples. Jizo is believed to aid sentient beings in their movement through the samsaric cycle and to protect deceased children as well as miscarried and aborted fetuses. Small statues of jizo, representing the fetus, are often dressed in children's clothing and presented with offerings of toys. Making offerings to jizo is a way to rectify negative karmic consequence of killing the fetus.

Buddhist Bioethics: Prospects

This entry has offered an overview of the relationship between Buddhist ideas and bioethical issues. The fundamental logic introduced concerning abortion, for example, also pertains to Buddhist discussions of other bioethical dilemmas. Most likely, ongoing Theravada and Mahayana debates over the morality of euthanasia or human cloning will also pivot on concepts of nonharm and compassion.

At least three areas remain for further study that will undoubtedly raise new and important questions about Buddhist bioethics. First, the Buddhist textual record that currently exists represents mostly the views of Buddhist males. What are the ethical perspectives, both past and present, of Buddhist women? Do Buddhist women have different views of bioethical issues than men? Second, as medical technology continues to impact traditionally Buddhist cultures, what new conflicts and challenges will emerge? Finally, in what ways will Western Buddhist (for instance, American Buddhist) syntheses of bioethical issues impact traditional Buddhist bioethics?

william e. deal

SEE ALSO: Authority in Religious Traditions; Compassionate Love; Death: Eastern Thought; Environmental Ethics: Overview; Ethics: Religion and Morality; Eugenics and Religious Law; Hinduism, Bioethics in; Medical Ethics, History of South and East Asia; Population Ethics: Religious Traditions, Buddhist Perspectives

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INTERNET RESOURCES

Barnhart, Michael G. 1998. "Buddhism and the Morality of Abortion." Journal of Buddhist Ethics Available from <http://jbe.gold.ac.uk/5/barnh981.pdf>.

Barnhart, Michael G. 2000. "Nature, Nurture, and No-Self: Bioengineering and Buddhist Values." Journal of Buddhist Ethics Available from <http://jbe.gold.ac.uk/7/barnhart001.pdf>.

Florida, Robert E. 1998. "The Lotus Sũtra and Health Care Ethics." Journal of Buddhist Ethics Available from <http://jbe.gold.ac.uk/5/flori981.pdf>.

Hughes, James J., and Keown, Damien. 1995. "Buddhism and Medical Ethics: A Bibliographic Introduction." Journal of Buddhist Ethics Available from <http://jbe.gold.ac.uk/2/hughes.pdf>.

Keown, Damien. 1999. "Attitudes to Euthanasia in the Vinaya and Commentary." Journal of Buddhist Ethics. Available from <http://jbe.gold.ac.uk/6/keown993.pdf>.

Lerdmaleewong, Malee, and Francis, Caroline. 1998. "Abortion in Thailand: a Feminist Perspective." Journal of Buddhist Ethics Available from <http://jbe.gold.ac.uk/5/aborti1.pdf>.

Tsomo, Karma Lekshe. 1998. "Prolife, Prochoice: Buddhism and Reproductive Ethics." Feminism and Nonviolence Studies Association. Available from <http://www.fnsa.org/fall98/tsomo.html>.