HINDUISM, BIOETHICS IN

The following is a revision and update of the first-edition entry "Hinduism" by A. L. Basham. Portions of the first-edition entry appear in the revised version.

Hinduism is a religious system that has grown and developed from the Vedic religion identified with Aryans who invaded the Indian subcontinent over a period of centuries in the second millennium b.c.e. It is rooted in an oral tradition that gave rise to four groups of sacred texts during a period that is difficult to pinpoint more precisely than 1500 to 900 b.c.e. Based on this informal collection of traditions, beliefs, and practices and the corpus of formal written treatises, which together provided a context for development of the medical system known as Ayurveda, Hinduism encompasses a range of values and codes of conduct highly relevant to a study of Indian bioethics.

Hinduism as we might recognize it today took shape in the Gupta Period (c. 300–500 c.e.), often regarded as the classical age of Hindu India. This entry will identify and briefly discuss basic concepts, which clarify the setting for analysis of bioethics in Hindu India, before focusing on medical ethics in Ayurveda. Just as they do now, social and cultural values defined standards of medical education and practice, ideas about ethical behavior as a determinant of health and disease, the balance of commercial and altruistic motives of clinicians, access to care and humane treatment, and the rights and responsibilities of patients and physicians.

Hindu Worldview

The doctrine of transmigration is a definitive concept for Hinduism. It postulates the existence of an innermost self (ātman) for all beings, ranging from the highest god to the meanest insect, that is essentially immutable. By becoming incarnate, this self becomes further involved with matter, which some philosophical systems hold to be fundamentally illusory and others regard as the primordial source of intellect, ego, elements, and the material world. According to the conduct of the embodied being, the soul or self is carried at death to another body, in which it flourishes or suffers according to previous behavior (the law of karma). This process is called samsāra. From an outsider's perspective, the force of karma operates as a tangible manifestation of an ethical system associated with principles of righteous conduct and moral values inherent in the concept of dharma, a difficult-to-translate term that embodies cosmic order, sacred law, and religious duty. Within the system, however, the effects of karma are typically conceived more as the operation of natural law governing the effects of behavior than a statement of moral and ethical values.

Transmigration links all living beings in a single system. Unlike the Judaeo-Christian and Islamic religious systems, Hinduism makes no sharp distinction between human and animal. Dharma as a guide to proper behavior is relative, not the same for different people or different beings. The ideas of karma and sam̧sāra motivate values of nonviolence (ahimsā) and vegetarianism. Nonviolence, which was never so prominent a value in Hinduism as it was in Jainism and Buddhism, has less stringent implications for laypersons than for ascetics, and it does not interfere with righteous warfare, punishment of criminals, or self-defense.

The process of transmigration is considered painful, and the main quest of classical Hinduism has been to find "release" (mokşa) from the cycle of birth and death and thereby enter a state of timeless bliss. For the orthodox schools of Hindu philosophy and systems of Buddhism and Jainism that sprang from them, knowledge provides a means of escaping this repetitive cycle of birth, death, and rebirth. Each of these schools has a somewhat different interpretation of the problem and the solution. Both the Sām̧khya school, identified with yoga practice and once very influential, and the heterodox sect of Jainism, define release as the complete separation of the individual soul from matter. The Advaita Vedanta system, which exerts the greatest influence on intellectual Hinduism, interprets it as a full realization of the illusory character of the material world, the speciousness of individual personality, and the recognition of the soul's identity with an underlying impersonal world spirit, often called Brahman. Theistic Hinduism of the ViśIştādvaita school, which has had the greatest influence on popular ideas, interprets release as union with the personal God not through knowledge but through devotion to Vişţu, who is identified with Brahman, the ultimate reality of the universe and out of whom the world repeatedly emerges in the course of cosmic cycles.

Ideally, release is the aim of all striving, but Hinduism recognizes the validity of other aims, which for laypersons are fully legitimate. The ascetic (sannyāsi), on the other hand, "who has given up the world," should pursue only release. Ordinary people approach this goal through gradual stages over many lives. For them there are three legitimate aims: dharma, adherence to religious and ethical norms in order to ensure a happier rebirth; artha, amassing wealth for the benefit of oneself and one's family; and kāma, seeking pleasure and the satisfaction of personal desires. These three aims are valued in descending hierarchical order, but each is fully acceptable for different persons at a particular stage of life and for caste-based communities, which may emphasize one of them.

The Hindu pantheon begins with one primeval being, or God, and innumerable supernatural beings, all of whom are endowed with individual volition. Some of these beings adhere to the will of the higher gods, but others oppose the work of creation. Battles between gods and demons, light and darkness, and good and evil were important features of the earliest Hindu literature, and these themes are widely represented in popular beliefs and practices. Complementing more intellectual naturalistic explanations that are also a prominent feature of Hinduism, some look upon the world as a place full of demons, which are normally at war with gods, and which can be potent factors in causing misfortune and disease.

Hindu cosmology refers to four ages (yuga) over the period of a great cycle (4,320,000 years). The current cycle, the Kali yuga, is the worst, but fortunately the shortest, lasting 432,000 years, about 5,100 of which have elapsed. Looking backward to better times provides a guide in this troubled age. Neither the doctrine of karma nor that of cosmic decline, however, implies fatalism. Human effort may influence the process, and it holds potential for gaining release from the personal cycles of birth and rebirth. Hindu texts emphasize the virtue of human effort (puruşakāra), rather than passive acceptance of adversity that may follow from destiny or chance.

Social Norms

The four great classes (varņa), constituting an eternal hierarchical social order, were believed to have emerged at the beginning of time from the body of the Creator as the fundamental basis of society. The Brahman (priest), the Kşatriya (warrior and ruler), the Vaiśya (merchant), and the Sūdra (worker) formed these four classes, each with different roles, responsibility, and status. Maintaining differences that distinguish each of them was a prerequisite of the social order, and any effort to violate the boundaries of social organization and behavior was an affront to nature and the gods, degrading for those at the top and punishable for those at the bottom. Below the four great classes were the untouchables, theoretically outside, but operating at the bottom of the social order. They performed important social functions that others considered polluting, such as removing garbage, cremating corpses, working in leather, and so forth. Contact between them and the other classes was strictly limited.

Although aspects of this class structure persist in Hindu society today, social conditions rarely operated according to textbook norms. More important and more complex in everyday life was the caste (jāti), a group of families generally following the same profession and theoretically contained within one of the four classes, though not always recognizably so in practice, especially in South India. Castes were also hierarchically graded and normally endogamous. Local councils of elders exerted great power over their members.

Family

Social research in recent years has emphasized the primacy of the family over the individual in Hindu and other societies outside North America and western Europe. Hindu individuals were more likely to define themselves with reference to the extended family (kula) as a corporate unit. Social responsibilities, which constitute underpinnings for the concept of dharma, rather than individual rights, were clearly the priority among ethical concerns. Except in some parts of South India, primarily Kerala, the family was patrilinear, patriarchal, and patrilocal, though the authority of the patriarch was limited by traditional law. He did not have the right to dispose of family property arbitrarily, nor did he have complete control over the lives of family members.

The ritual of śrāddha, whereby dead ancestors retained a presence, sustained by the living, was a powerful force in shaping the character of Hindu family life. A male descendant to perform the śrāddha, a ritual offering of rice balls (piņḑa), was needed not only to sustain the ancestral lineage but also to avoid one's own suffering in the afterlife. In view of heavy child mortality, it was incumbent upon families to produce as many children as possible, in the hope that at least one surviving son would maintain the lineage, attend to the spiritual needs of the ancestors, and contribute to the economic well-being of the family.

A Hindu wife was integrated into her husband's family, and theoretically (though not always in practice) completely subordinate to him. In many communities it was considered indecent to leave a girl unmarried after her first menstruation, and marriage normally required the payment of a heavy dowry. Thus, the birth of a daughter was often looked on as a misfortune. Although female infanticide has been practiced and persists in some parts of India, the practice is completely without foundation in the Hindu scriptures, which look upon abortion and infanticide as grave forms of murder.

Prospective parents employed various techniques to increase their chances of bearing a male, rather than female, child. Diet and activities of a pregnant woman were believed to influence the sex, physical features, and character of the offspring. Treatises of Ayurveda advise that intercourse on even days after the onset of menstruation produces sons, and on odd days it produces daughters (Caraka, iv. 8. 5). Pumsavana rites to alter the sex of a recently conceived embryo and ensure the birth of a male child are discussed in the texts of Ayurveda. They are also discussed in religious treatises of the Veda and other texts that detail proper Hindu codes of conduct (dharmaśāstra) (Kane).

In recent years profitable ultrasound clinics have proliferated in India, in some states illegally, to make use of modern technology to identify and abort female fetuses. Responding to a culturally based gender bias and a persisting dowry system that taints perceptions of female children as economic liabilities, this ultrasound technology challenges the viability of pumsavana clinics previously established in some Ayurvedic hospitals and employing traditional Hindu medical methods for assuring the birth of male children.

Individual Conduct

Within the framework of the three aims of life (purusārtha) acceptable for the high-caste individual were a series of ritual observances and taboos throughout life. Sacraments beginning before birth and continuing after death marked the progress of life. The Brahman was expected to devote a considerable amount of time each day to prayer and ritual, and members of other castes were encouraged to imitate him.

The aim of many of these sacraments and taboos was to maintain ritual purity. Although conceived with reference to another conceptual framework, many practices also maintained a hygienic standard contributing to health in a tropical climate. Notable examples include insistence on a daily bath, the custom of eating with the right hand and washing the anus and sexual organs with the left, the ban on eating cooked food left overnight, and a strict taboo against contact with human corpses and animal carcasses. The bodily fluids of others, such as saliva and mucus, are considered polluting, and contact with anything contaminated by them, such as used dishes or drinking glasses, was to be avoided.

Social values and a conflicting emphasis in various texts of classical Hinduism portray an ambivalent attitude that both exalts and denies sexuality. Vedic texts regard sexuality as a metaphor for a ritual sacrifice. The Bŗhadāraņyika Upanişad (vi. 2. 13), among the best known of this speculative genre of Hindu scriptures (Upanişad), identified woman as a sacrificial fire fueled both by her own and her male partner's genital organs in the act of sexual intercourse. Semen is an offering to this fire, which may generate a person.

In later texts, however, sex is affirmed as a valid source of gratification, a legitimate pursuit among the three aims of life: righteousness, wealth, and pleasure. Erotic temple art and texts devoted to the details of enhancing sexual gratification, such as the Kāma Sutra, document a cultural sanction of pleasure seeking for men. These texts acknowledge female sexuality but consider it primarily from a male perspective—how to attract and please a man. Hindu texts concerned with moral codes of conduct (Dharmaśástra) emphasize chastity and procreation more from the classical period onward than previously (Bhattacharyya).

Even for men, classical Hinduism confines sexual activity to one stage of a man's life. An initiation ceremony (upanayana) that preceded a long period of celibate studentship was a milestone for upper-caste boys. Afterwards, a young man was married, normally to a bride chosen by his parents, and raised a family. According to the ideal, he was expected to give up family cares in late middle age to devote the rest of his life to religion and to strive for liberation. Ascetic values discouraged sexual activity, which not only distracts the individual from a quest for release from the cycle of rebirth but also results in the loss of physical and spiritual power.

In addition to the emphasis on a moral code of religious practices, Hinduism also emphasizes ethical principles of social relations. The principle of nonviolence has often been interpreted in a positive sense, as actively benefiting others. Though subject to the constraints of conflicting values in a comprehensive social order, Hindu texts and practices encourage virtues of honesty, hospitality, and generosity. Explicit codes detailing how guests are to be received, fed, and looked after emphasize hospitality as a social value (see chap. 21 on receiving guests in Kane). The Taittirīya Upanisad (i. 11.2) admonishes students to treat parents, teachers, and guests as gods.

Hindu Medicine

A complex medical system, known as Ayurveda, "the science of (living to a ripe old) age," developed in India over the first millennium b.c.e. The theory of health and disease according to Ayurveda refers to a humoral physiology based on the balance of three substances (dosas): wind (vāta), bile (pitta), and phlegm (kapha). They are recognizable indirectly by their impact on health and illness. The excess of one or another and their locus in the body or among bodily elements (dhātu) determines the nature of specific physical and mental diseases, their manifestations, and subtypes.

Although karma, demons, and deities may also play a role in producing ill health, it is a relatively minor role in the medical texts and more of a concern in other settings. The role of a physician practicing Ayurveda is to restore the harmony of humoral balance with medicines, purification, massage, diet, and directives for appropriate lifestyle. Experience with an exceptionally wide pharmacopoeia and careful observations of the symptomatology, clinical course, and treatment response of various diseases—especially chronic conditions for which Western medicine does not provide a clearly superior alternative—have enabled practitioners of the system to maintain the respect of a large number of South Asians who continue to use it.

Health, Disease, and Morality

Ayurveda, despite its emphasis on the humoral basis of health and disease, also recognized external (āgantu) causes that provided a better account than endogenous (nija) causes—that is, humoral imbalance—to explain some medical conditions. Karma referred to the impact of misdeeds in a previous life. Irreverent, unethical behavior and other violations of codes of conduct (prajñā-aparadha) in one's current life were not limited to effects on that individual; they could also affect offspring (Caraka, iv. 8. 21, 30). Serious transgressions of the king might also produce epidemic disease and disasters (janapadoddvamsana) in his kingdom (Caraka, iii. 3). Moral conduct, affecting individuals, distinct from epidemics affecting populations, operated through the allembracing doctrine of karma; in some instances, karma explained health or disease if the humoral theory or demonic possession could not, and in other instances, it provided a complementary explanation.

Illnesses might be caused by the sins or shortcomings of a previous existence; longevity was also explained by this idea of karma. The doctrine encouraged inner acceptance of disease and gave a ready-made explanation of its cause, but nowhere is a person advised to submit to illness without attempting its cure. Karma could explain otherwise mysterious congenital defects. Someone born with a deformed hand, for example, could be said to have incurred this misfortune as a result of an evil deed (for instance, striking a Brahman) committed by the same hand in a previous life. This did not necessarily discourage efforts to improve the condition by surgery, since the duration of the punishment through karma was not known, and the trouble might be only temporary. Since the evil brought about by karma cannot be estimated with certainty, and the bad effects of sins can be offset by the merit gained by good deeds, there was every reason why a sick person should seek all available medical help to achieve health.

Other factors besides karma were believed to promote health or disease. Devotion (bhakti) to God, who might set aside the law of karma for the faithful, promoted longevity and health. Neglect of religious duties and lack of faith, on the other hand, might lead to the withdrawal of divine protection, increasing the risk that demons might exert their influence, leading to disease or madness.

More closely linked with ethics was the general view in the medical treatises that equanimity and kindness are therapeutic in their effects. Excess in every respect is looked on with disfavor by the medical texts. An impressive emphasis on the values of moderation, altruism, and love to promote health and longevity is found in the seventh-century text of the Buddhist physician Vāgbhata, the Aşţāṅgahŗdayasam̧hitā (1965, i. 2). This work, along with the Caraka Samhitā and the Suśruta Samhitā, is among the so-called great-three (brhattrayī) texts of classical Ayurveda. After reviewing the benefits of exercise and symptoms resulting from overexercise, it enjoins the physician to support those who are sick, poor, or needy and to treat them with respect.

Mental and spiritual training in concentration and meditation, commonly known as yoga, was also believed to promote health and longevity. Yoga is still widely practiced both as treatment for clinical problems in yoga clinics of some Indian hospitals and more generally to promote health and well-being. Different forms of yoga practice involve physical postures and exercises (hatha-yoga), meditation (rāja-yoga), or both. These produce not merely health and longevity; they also provide a way for the most advanced adepts to attain liberation from the cycle of rebirth, and hence immortality.

Ethics of Medical Practice

The activities of the physician (vaidya) were closely linked with the doctrine of the three aims of Hindu life (Caraka, i.30. 29; Vāgbhaţa, i. 2. 29). Viewed as complementary, rather than contradictory, they guide appropriate behavior. By relieving suffering and adding to the sum of human happiness, a physician (assumed in the texts to be a man) fulfills the first aim, carrying out his religious duty; from the generous fees of his wealthy patients he achieves the second aim, riches; while the third aim, pleasure, is achieved by the satisfaction he obtains, first, from a high reputation as a healer and, second, from the knowledge that he has cured many people whom he loves and respects.

The last two aims were not to be disparaged. The few famous physicians described in story and tradition were not selfless servants of humanity but very wealthy men—in that regard resembling successful practitioners of modern times.

There appears to have been no ban to keep a physician from advertising his skill. As the example of Vāgbhata indicates, Hindu and Buddhist medical traditions were closely linked. A Buddhist text, the Mahāvagga, provides more biographical detail than the Hindu sources about medical practice in the same society. It refers to the material interests of a renowned doctor in his youth, Jīvaka, recently qualified and in search of patients. As he entered an ancient Indian city, to earn money for his onward journey, he walked through the streets inquiring, "Who is ill here? Who wants to be cured?" (Mahāvagga, viii. i. 8–13).

Although Jīvaka's concern for his fees was matched by qualifications and skill, it appears that quackery was also rampant in ancient India; charlatans would come canvassing as soon as they heard that a well-to-do person was sick (Caraka, i. 29. 8–12). Recognizing such problems, Suśruta (i. 10. 3) referred to a system of licensing qualified medical practitioners. Texts on politics and statecraft suggested punishments for doctors whose ineffective treatment resulted in injury or death (Kauilya, iv. 1; Kane). Caraka also advocated a high moral standard for a proper physician, based on religious duty (dharma). At the outset, a physician's training began with a solemn initiation, at which his teacher (guru) instructed him that he was to live a frugal and ascetic life, celibate and vegetarian, while undergoing training. He must obey his teacher implicitly "unless instructed to commit a mortal sin." The prescribed instruction continues:

When you have finished your studies, if you want to have a successful, wealthy, and famous practice, and to go to heaven when you die, you must pray every day, when you get up and go to sleep, for the welfare of all beings, especially cattle and brahmans, and you must strive with all your power to heal the sick. You must not betray your patients, even at the risk of your own life.… You must always be pleasant of speech … and always strive to improve your knowledge.… Having entered a patient's home, a physician's speech, mind, intellect, and senses should be devoted to nothing other than caring for the patient. Any peculiarities of the household you may learn about should not be disclosed outside. (Caraka, iii. 8. 13. 4–5, 7)

This well-known passage has been compared with the Hippocratic oath. The text also addressed other persisting dilemmas of medical practice. If it becomes clear that a patient in treatment has a fatal condition, the matter of whether or not a doctor should disclose this information was left largely to the doctor's discretion. Caraka advised that if a physician concludes that the condition of the patient is hopeless and if he believes that it might shock the patient or others, he should keep this knowledge to himself.

The same chapter of the Caraka Sam̧hitā also contains advice about when a physician should refuse to provide treatment. He should not treat the king's enemies, women unattended by a husband or guardian, or patients for whom a request for treatment comes as they are about to die (Caraka, iii. 8. 13.6). Accepting a terminal case might damage his reputation.

The Hindu medical tradition is based on a relatively stable theory of health and illness, but it advocates a policy of openness to new ideas about treatments. Although the theoretical basis rooted in the doctrine of the three humors has always guided Ayurveda and undergone little modification over the course of time, the vaidya was advised to be constantly on the lookout for new drugs and treatment methods. Compared chronologically, the texts show a steady increase in the number of items in the pharmacopoeia. Even after his long apprenticeship was over, the physician was counseled to continue to improve his knowledge by studying his patients and inquiring about unusual but potentially useful remedies from hermits, cowherds, and hillmen (Suśruta, i. 36. 10).

Professional gatherings of physicians were regarded as valuable opportunities for the exchange of knowledge that could enhance a clinician's skills. The descriptions of these colloquiums distinguish friendly discussions from hostile debates, and the exchange of information was not necessarily free and open. Many physicians guarded proprietary knowledge not recorded in professional textbooks, knowledge they might reveal to prove a point in the heat of impassioned debate. Entering into professional discussions, the clinician is advised not to boast, embarrass others, or fear discomfort. In the company of knowledgeable colleagues, he is advised to listen attentively and speak freely. The text also advises how to handle hostile discussions with superiors, inferiors, and equals. "The wise never applaud a person engaging in hostile discussion with a superior … but the following methods help in quickly overpowering an inferior disputant.…" (Caraka, iii. 8. 15–21; see also the remainder of chap. iii. 8).

The texts encouraged the physician, though he might be wealthy and unfettered by any rules of an ascetic character, to consider himself a sort of secular priest with a special, almost supernatural charisma bestowed on him by the initiation ceremony at the beginning of his studies. The high-caste man who had undergone the normal Hindu initiation (upanayana) was "twice-born" (dvija), and thus superior to the Śudra or woman, who had only one birth. The vaidya was even a step beyond, "thrice-born" (trija). As the prescribed words of his teacher show, this exalted status required a high standard of fortitude and conduct. The student was taught that as a physician he should always be "of calm mind, pleasant speech, … the friend of all beings" (Suśruta, i. 10. 3). To some extent professional identity relieved him of the burden of caste taboos. He could enter the homes of people of a lower caste than his, handle their bodies, and even taste their urine when making a diagnosis.

Notwithstanding vegetarian cultural values, treatment employed animal products to compound drugs, and they appear to have been prescribed freely. The taboo that proscribed handling a corpse, however, may have applied to most physicians. Most medical texts do not advocate the actual dissection of a cadaver; Suśruta Sam̧hitā (iii. 5), however, is an exception. It advises that for a surgeon to study the position of internal organs, a carefully selected dead body should be placed in a cage after removing excrement from the entrails, positioned in a stream with a swift current, and examined after seven days as it begins to decompose. In that way the body might be studied in each anatomical layer, beginning with the skin.

Although concerns about ritual pollution and principles of nonviolence inhibited anatomical study and surgery in Ayurveda, in recent years they appear to have had surprisingly little influence on modern medicine in India, known as allopathy, with respect to the burgeoning surgical practice of organ transplantation. Concern about the adverse impact on the transmigration of souls has had a negligible effect on the transmigration of vital organs from one person to another. Bombay has acquired a dubious distinction as a world center for transplants from unrelated live donors, spawned by a profitable private-practice medical industry, an impoverished subpopulation willing to donate organs for a fee, and enterprising brokers whose activities reflect little concern for the ethics of these practices.

Access to Healthcare

The provision of free medical care to the poor was looked on as part of a king's duty to protect his subjects, which was generally interpreted in a positive sense (Caraka, i. 30.29; see also the background essay in vol. 1, pp. 254–264 of P. M. Mehta's translation). From the days of the benevolent Buddhist emperor Aśoka in the third century b.c.e., the better rulers of India responded in some measure to this responsibility. Medical clinics of one kind or another, where professional doctors provided free services to the poor, existed in many cities. These were sometimes supported by the states, but others were often financed by private charity. In South India especially, hospitals and dispensaries were often attached to the great temples. Medical services might have been subsidized by doctors themselves, for they were encouraged to treat the poor, learned Brahmans, and ascetics without charge (Suśruta, i. 2. 8; vi. 11. 12–13). Free medical services in South and Southeast Asia, however, were more extensive in Buddhist Sri Lanka and Cambodia.

Reasoned Suicide and Mental Health

The aim of the idealized ascetic to attain release and end the cycle of rebirth provided an acceptable rationale for suicide in highly selected circumstances. Sallekhaná is a Jain practice sanctioned for elderly mendicants involving ritual fasting that ends in death; its aim is for the individual to meet the final moment with utmost tranquillity (Settar). The Dharmaśāstra literature, which outlines Hindu codes of conduct, also refers to another form of religious suicide, the "great journey," justified by incurable disease or great misfortune (Kane). Those who undertake this ultimate renunciation in the final stage of life proceed in a northeasterly direction, "subsisting on water and air, until his body sinks to rest" (The Laws of Manu, 6. 31). Other means of accomplishing religiously motivated suicides include jumping from a height (bhrgupāta), often associated with pilgrimage sites where these suicides were most frequent, such as Śravana Belgola, west of Bangalore in South India, and Prayaga (modern Allahabad) in the North.

Questions about these carefully reasoned suicides, usually sanctioned only for the elderly, were framed in religious rather than medical contexts, unlike current debates about euthanasia and assisted suicide in the West. Nevertheless, issues identified as appropriate justification by those who advocate these practices in both settings are comparable, especially the role of terminal illness and functional disability. Whether one regards these socially sanctioned self-willed deaths as suicide or something else is a debatable matter. Some scholars avoid the stigmatized English term (Settar), although more commonly suicide is used descriptively, regardless of whether it is proscribed.

Although Hindu texts were very much concerned about ethical questions that ultimately lead to sanctioning or condemning suicides, based on their circumstances, the context of the discourse was strikingly different from that of present-day debates about physician-assisted suicides. Suicide in the West typically raises questions about deviance and mental disorder. Concerns for victims are framed in clinical terms with a focus on prevention and cure of psychopathology associated with suicidal impulses. Hindu traditions that consider suicide are concerned with a different set of questions, which focus not on deviance but on cultural values. Religious suicides of ascetics and pilgrims and the self-immolation of a widow on the funeral pyre of her husband (anumarana)—an act that has come to be known as sati, after the Sanskrit term for the "righteous woman" who undertakes it—were not discussed in medical contexts. Modern criticism of sati proceeds from social, economic, and feminist perspectives; it focuses on questions about the deviance and disorder not of the victims but of societies that disvalue women, especially widows.

Suicide was regarded neither as a defining feature nor an important symptom of mental disorder. Mental disorders (unmāda), however, were recognized and classified according to threatening, disorganized, and disordered behaviors, and by disturbing emotional states. The classification of some of these mental disorders fit the characteristic humoral framework, but others did not. Like some childhood diseases discussed in the texts (but few other health problems), they were explained by the influence of demons and deities. The texts prescribe a mix of gentle, humane treatment, as well as not-so-gentle efforts to restrain and shock patients into normalcy with threats of harm and false reports of the death of loved ones. Offerings to demons and deities (bali) and medicines to correct a humoral imbalance of excessive wind, bile, or phlegm were also prescribed for mental illnesses attributed to these respective causes.

Conclusion

Many issues that remain concerns in modern medical practice were recognized and addressed by Hindu religious texts, codes of conduct, and Sanskrit treatises of Ayurveda. The medical texts discussed responsibilities of the physician to society, patients, and colleagues in terms that recognized the professional nature of these interactions, distinctive social values, and political forces. Medical theory, which was primarily humoral, incorporated a moral basis for explaining health and illness of individuals. Some questions that have become major concerns for medical ethics in the West, such as the status of rational suicide, were considered in the context of Hindu traditions other than medicine.

Recent developments in biotechnology have placed controversial questions about bioethics and cultural values near the top of an agenda for equitable social policy in South Asia. The ongoing debate that follows from the impact of new technologies should be informed by an appreciation of the cultural and historical contexts in which these questions emerge.

mitchell g. weiss (1995)

SEE ALSO: Buddhism, Bioethics in; Confucianism, Bioethics in; Daoism, Bioethics in; Death, Eastern Thought; Ethics, Religion and Morality; Eugenics and Religious Law: Hinduism and Buddhism; Healing; Health and Disease; Jainism, Bioethics in; Sikhism, Bioethics in

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