- Pinit Ratanakul, Ph.D.
Center for Human Resources Development,
Mahidol University, 45/3 Ladphrao 92 Bangkapi
Bangkok 10310, THAILAND
Eubios Journal of Asian and International Bioethics 9 (1999), 45-46.
In a much wider context, in the allocation of limited medical resources at the micro-level loving care for a particular patient needs to be tampered by the concern for others who also need these resources for their recovery or survival. Similarly at the macro level loving care means a fair distribution of limited resources throughout the rural and urban areas of the country. Accordingly loving care embraces justice. This combination is essential for without justice love is ineffective and sentimental while justice without love can be rigid and heartless.
From the Buddhist perspective loving care at the mundane level implies the preservation, protection and restoration of life. In Buddhism though life in this world is characterized by suffering it is still valuable. Therefore the first precept prohibits the taking of life in whatever form. But in the concrete life situation there are many challenges for the physicians In the practice of loving care for the patients. The most challenging problem has to do with the need to decide whether the prolongation of life is desirable. In cases of terminal patients, severely deformed newborns, and those in permanent vegetative state Buddhist bioethics does not offer clear-cut answers. Some Buddhist ethicists make a distinction between "killing" and "letting-go-of-life" Here the important thing is the role of intention on the part of the physician and/or those concerned. Should life be simply supported when it is very clear that for the terminal patients or the severely deformed newborns or the PVS patients they cannot have even minimum quality of life or can survive only at great and inordinate expenditure of limited medical and other resources as well as energy and time of health care providers, institution, and the family? For these Buddhist ethicists in the circumstances mentioned above, "letting-go-of-life" seems to be the best expression of loving care which is not to be understood as extending life at all costs. But some Buddhists would argue that "letting-go-of-life" also violates the first precept. However it is clear that Buddhism is against euthanasia, the quick, supposedly mercy killing to relieve pain. With regard to the argument that one is seeking to hasten the death of another in order to be merciful or to show loving-kindness. Buddhism considers it a form of paternalism and self deception People nave different pain thresholds and psychological, emotional and spiritual factors play a great part in how much pain or suffering people can endure. People can endure pain if they find meaning in it. We might think that another is suffering unendurable pain and therefore ought to die. In this we are paternalistically imposing our values upon them because we would not want to go on living in such circumstances. But this does not mean that this, even a painful life, is meaningless to them. In Buddhist psychology, the felt desire to end another's suffering may be derived from our own inability to cope with it, and our own anguish in watching another suffer. Actually, we want to save ourselves from further suffering, not them. Instead of euthanasia the practice of loving care to the dying means helping them to reach their end peacefully and, if possible, in the wholesome state of mind.
In the case of abortion loving care means avoiding condemning those women whose life situations have made the decision to abort seems unavoidable, and treating them with understanding and sympathy. This precludes any form of assistance given in the process of abortion. Even when the fetus is known to be severely deformed the fetal abnormalities cannot be used as grounds for abortion. In this case loving care is extended to the unborn. This extension raises the question whether loving care means that the unborn babies who, if allowed to be born, are more likely to die an agonizing death, should be aborted to prevent suffering inflicted on them and on the family. This is a difficult question Buddhist bioethics has to deal with to help the Buddhists in the practice of loving care to suffering people. In the life cycle (samsara) fraught with the potentiality and actuality of human suffering the relief of human suffering is the primary moral virtue. To alleviate the suffering of the parents prenatal diagnosis to detect genetic disorders of the fetus should be encouraged for married couples to prepare them for the proper attitude towards deformed babies, when it is inevitable. And to prevent suffering to be inflicted on parents those known to be carriers of genetic diseases are advised to forego parenthood and seek other means of having children, if they so desire.
It may be concluded that in Buddhist bioethics love occupies a central place. It is the basis of the foremost Buddhist moral principle, namely, loving kindness or compassion which leads to the practice of loving care. Loving care does not mean mere protection of life as it involves complex factors to be reckoned with. In the discussion of the right to life among Buddhist ethicists the present trend is to bring the Buddhist concept of interdependence (patichasamuttipada) into such discussion. Following this teaching of interdependence of all being as. Buddhists see human actions in the totality of their circumstance and human responsibility in the inter-webbing of relationships of self to self, others and society. Accordingly although the final decisions concerning his/her life should be made by each person these decisions are to be made in consideration of the suffering the decisions would inflict on other individuals, families, and society.
Of course, there are people who will question whether loving care alone is sufficient basis for making ethical decisions in the practice of modern medicine. To this question it should be pointed out that the Buddhist concept of loving care is a comprehensive notion embracing all other moral principles uphold in western bioethics i.e. respect for persons and their autonomy, beneficence, non-maleficence, and justice. In Buddhist bioethics the principle of loving care is emphasized more than other moral principles because Buddhism recognizes the complexity of life situations where legalistic observation of moral rules can unintentionally lead to greater evils and abdication of compassion. In real life there are many cases which are in the twilight zone. In such cases the nature of intention behind deed is of primary significance and thus should be taken into account before we rush in negative judgment on the party concerned. When life situations force people to make unpleasant decisions, hard choices between greater and lesser harms, greater and lesser good, we should not overburden them with a sense of guilt but evaluate the reality with compassion to lessen their suffering caused by wrong decisions. Only by avoiding the rigidity and laxity can the practice of compassion be achieved. Where would society be, where would medicine be were it not for the example of those who practice the Buddhist ideal of loving kindness or compassion consecrated themselves to the welfare of others even at the cost of their own comfort and benefit.
Is it now the time for a paradigm shift from the over-emphasis on individual rights to loving care as a moral imperative in the practice of medicine and in other areas of life?