Hindu Samskriti - Medical Ethics

 Medical Ethics

Hindu Insights on 25
Sensitive Areas Frequently
Encountered by Physicians

Hindu medicine, known as ayurveda, the science
of life,” has a highly developed system of practical
ethics derived from the Hindu principles of
nonhurtfulness, the sanctity of all life, the existence of the
soul separate from the body and a willingness to accept
life’s circumstances as defined by one’s karma and dharma.
In 1999, Hinduism Today was approached by the Texas
Medical Association to help them revise and expand a
book on medical issues called Faith of Our Patients. When
it was first published in 1978, the booklet dealt with the
Catholic, Protestant and Jewish views of 14 “problem areas”
most frequently encountered by physicians, including autopsy,
abortion, artificial insemination, prolongation of life
and organ transplants. They had recently expanded their
list and sought to include the views of Hinduism and Buddhism
to accommodate increased religious diversity among
their patients.
To respond to their request, we enlisted the help of Swami
Bua, Swami Satchidananda,
Swami Ranganathananda
of the Ramakrishna Mission, Swami Chidanand
(Muniji), Swami Omkarananda,
Swami Pragyanand,
of Chinmaya Mission, Satguru Sivaya
and his successor, Satguru Bodhinatha
Veylanswami. We also consulted with Dr. Virender Sodhi,
an ayurvedic and allopathic doctor in Washington, and
Cromwell Crawford of the University of Hawaii, an Indianborn
specialist in Hindu medical ethics. The assembled responses
below represent the broad consensus of this group,
with occasional differing opinions. It remains a work in
progress, to be updated as required.
Fortunately, as pointed out by Professor Crawford, the
ancient codifiers of ayurveda, Sushruta and Charaka, carefully
considered and documented the ethics of their profession
and its various medical procedures. They did so within
the context of a Hindu view of man, which, as Swami Ranganathanananda
put it, “is that his essential, real nature
is the atman or Self, which is immortal, self-luminous, the
source of all power, joy and glory. Everything that helps
in the manifestation of the divinity of the soul is beneficial
and moral, and everything that obstructs this inner unfoldment
is harmful and immoral.” With this over-arching
in mind, it was the aim of the ayurvedic physician to
preserve the well-being of the community through maintaining
health and removing the threats to life of humans
and nonhumans. The ancient healers held that pathogenesis,
the development of disease, is not caused randomly or
simplistically by external agents through infection or injury.
Rather, the development of any disease is also an expression
of karma: the results of an individual’s past actions. It
is hoped that this compilation of Hindu medical ethics will
provide a spiritual view of the medical concerns faced by
all Hindus, one that will balance the prevailing humanistic
view by presenting a traditional Hindu perspective from
which to evaluate these important matters of life, death
and the beyond.

End-of-Life Issues
Hindus regard death as a most exalted human experience, the migration
of the soul from one dimension of consciousness to another,
a transition we have all experienced many times. Death is not
to be feared, neither unnecessarily accelerated nor relentlessly
delayed. In considering the following end-of-life issues the Hindu
seeks to preserve the natural timing of death, while humanely
comforting and being present for the patient in a spiritual environment.

Preparation for Death
“With our strong conviction that all our actions in the present life
will be the cause for the effects in our future life,” says Swami
Bua, “a wise Hindu facing death goes into introspection of all his
deeds during the present life and sincerely tries to make amends
for the wrong deeds. Wherever it is beyond correction, he repents
and wholeheartedly prays for forgiveness in the form of chanting
mantras. He plans to visit holy places and temples, health
permitting. When and if he becomes immobile due to physical
conditions, and the indications are that he is nearing his end, his
children assemble around him and give him holy water from the
Ganges. They sing bhajanas, holy songs, and chant mantras, often
in a 24-hour-a-day vigil.” Satguru Sivaya Subramuniyaswami
wrote, “Blessed with the knowledge of impending
transition, we settle affairs and take refuge in
japa, worship, scripture and yoga—seeking the highest
realizations as we consciously, joyously release the
world. Our soul never dies; only the physical body dies.
We simply step out of the physical body and are in our
astral body, going on in the mind as usual. For Hindus,
death is nobly referred to as mahaprasthana, ‘the great
journey.’ The awareness, will, memory and intelligence
which we think of as ourselves continue to exist in the
soul body. We approach death as a sadhana, as a spiritual
opportunity. To leave the body in the right frame
of mind, in the right consciousness, through the highest
possible chakra, is a key to spiritual progress.”

Pain Control
Hindus regard pain management as an important duty
of caretakers.
“If an individual opts to undergo the
pains, he or she should be left alone,” Swami Bua noted.
“Otherwise, it is the duty of the people around to help
reduce his suffering. If a person is relieved of pain, his
thoughts become sublime with gratitude and the feelings
of amity, affection and love. Nobody should be allowed
to die with the feelings of bitterness, feelings of
wanting or feelings of unfulfilled duties. We should do
everything possible to keep the dying person comfortable
till his end, which is determined by Him.” Opiates
and other drugs have been used for this purpose
in Hindu medicine for thousands of years, according
to Dr. Sodhi. However, he explains,
“They try not to
administer so much pain-killer as to alter or lose consciousness.”
Excessive pain-killers can dull awareness
and inhibit the conscious transition that is the Hindu

Prolongation of Life
Ayurveda classifies disease as either sadhya, those that
can be effectively treated and cured, or asadhya, those
that cannot. It further classifies untreatable diseases as
those which can be managed for an acceptable quality
of life, such as diabetes, and those which cannot, such
as terminal cancer. If treatment cannot provide the patient
a quality life, then it is considered better to give no treatment
beyond palliative measures.

The “Right to Die”
It is the law in many parts of America that a hospital must do
everything possible to keep a patient alive as long as possible, no
matter what his state of consciousness, or the prognosis for a useful
existence. If the patient’s financial resources are exhausted,
then the state must pay. To avoid being kept alive against his own
wishes, he must make a “living will” in advance, to specify under
what conditions he declines further treatment, and to assign a
person to make that decision for him if he cannot. A living will
can preserve the resources of a family, avoiding costly and ineffective
heroic treatment. Hindus accept the natural timing of life
and of death and do not strain to gain a few months of strugglefilled
life at great effort and expense.

“Do-Not-Resuscitate” Orders
Part of a living will deals with “Do-not-resuscitate” orders. These
instructions tell the doctors when they should not use cardiopulmonary
resuscitation (CPR) or other measures to revive a person
if his heart or breathing has stopped. Again, the decision centers
around the likely quality of a life so revived. A drowning or heart-
attack victim may, after resuscitation, go on to a full recovery. But
for terminally ill patients, resuscitation may only delay the inevitable,
prolong the suffering and interfere with the natural timing
of death. Sivaya Subramuniysawami (Gurudeva) noted, “To
make heroic medical attempts that interfere with the process of
the patient’s departure is a grave responsibility, similar to not letting
a traveler board a plane flight he has a reservation for, to keep
him stranded in the airport with a profusion of tears and useless
conversation. To prolong life in the debilitated physical body past
the point that the natural will of the person has sustained is to
incarcerate, to jail, to place that person in prison. The prison is
the hospital. The guards are the life-support machines and the
tranquilizing drugs.”

Removal of Life Support
A critical and closely related issue any living will should address
is the removal of life support. Modern machines can keep patients
alive when they are unable to breathe or take nourishment, and
when organs cease to function, including the heart. Life-support
patients may be in near-normal consciousness, semi-conscious, comatose
or “brain dead,” with no brain wave activity at all. Even
common kidney dialysis machines and ventilators qualify as “life
support,” for if turned off patients would die. A much discussed
issue is whether turning off a life support machine is “killing” the
patient or “letting him die.” The issue is further complicated by
rapidly advancing technology whereby ever more seriously ill or
injured patients can be kept alive.
In Dr. Sodhi’s opinion, removal of life support would be justified
in a case where there is no brain-wave activity, for “according
to ayurveda, that person is dead. Sustaining his condition is
more like the torture of the soul, and ayurveda prohibits it.” While
ancient Hindu medicine did not anticipate many of the abilities
of today’s complex machines, it did discuss the issue of nourishment,
which is a part of any life-support system. Hindu scripture
allows for the termination of food and water at the request of a
terminally ill patient who chooses a self-willed death by fasting,
prayopavesha. The patient can specify in advance in his living
will under what conditions nourishment, hydration
or other life
support should be withheld. Knowledge of the patient’s intentions
[or wishes] alleviates the karmic burden of the doctors and family.
The ideal, Gurudeva counseled his own devotees, is to not be put
on the life support machine in the first place when there is little
chance of recovery.

Assisted Suicide
Hindu philosophy does not support “assisted suicide,” deliberately
causing the death of a patient at the patient’s own request by drugs,
overdose of painkillers or other lethal means. In extreme circumstances
of unbearable agony where others turn to euthanasia or
mercy killing, Hindus know the sufferer may refuse food and water.

Hindus believe that life is sacred—God’s grace—and therefore
it is not ours to end. Suicide only postpones and intensifies the
karma one seeks escape from, requiring several lives to return to
the evolutionary point that existed at the moment of suicide, thus
it is a spiritual step backwards. In cases of terminal illness, under
strict community regulation, tradition does allow prayopavesha,
self-willed religious death by fasting, as stated above. Gurudeva
taught, “The Vedic rishis gave the anguished embodied soul a way

to systematically, nobly and acceptably, even to loved ones, release
itself from embodiment through fasting. The person making such
a decision declares it publicly, which allows for community regulation
and distinguishes the act from suicide committed privately
in traumatic emotional states of anguish and despair. Ancient lawgivers
cited various stipulations for prayopavesha: inability to perform
normal bodily purification; death appears imminent, or the
condition is so bad that life’s pleasures are nil. The gradual nature
of prayopavesha is the key factor in distinguishing it from sudden
suicide, for it allows time for the individual to settle all differences
with others, to ponder life and draw close to God.” It also gives the
person time to reflect and reconsider his decision.

Definition of Death
“When the physical body dies, this automatically severs the silver
cord that connects the astral and physical bodies,” Gurudeva explained
in Merging with Siva. Metaphysically, this is the point of
death. Physically, death can be defined as the cessation of breath,
heartbeat and brainwave activity, in that order. Even then, it may
be possible to revive a person, and the patient may report a “neardeath
experience” of beginning the transition to the next world but
being pulled back. Decay of the body is the definitive sign of death.

Autopsies are the examination of a dead body to learn the cause
of death. Hindus believe that autopsies are disturbing to the still
aware soul which has just separated from the body and should
therefore be avoided unless required by law. Similarly, embalming,
which replaces the blood with a preservative fluid, is ill-advised.

Use of the Body After Death
In ancient times, doctors around the world used dead bodies to
understand anatomy and practice surgery. In India, the bodies
used for this purpose were those unclaimed by relatives or
friends. According to Swami Bua, “In the Vedic Age, dissection
and mutilation of body were considered detrimental to the fulfillment
of life. Yet, if we consider that once the spirit leaves the
body, the lifeless body has no karmic obligations, then it may be
okay.” Swami Pragyanand points out that autopsy and dissection
were practiced by Sushruta, an early pioneer of ayurveda. Swami
Tejomayananda says, “The body of the deceased is treated with
reverence. The feelings and sentiments of the family also do not
favor dissection. People have some fear that the astral body may
be hurt by these intrusions or some harm may come to the family.”
Gurudeva similarly held that what happens to the dead physical
body is disturbing to the soul, and did not advise his devotees to
donate their bodies to science.

Burial and Cremation Practices
Cremation, ideally held within 24 hours, is the traditional system
of disposing of dead bodies. It has the benefit of releasing the soul
most quickly from any lingering attachment to the earth plane.
Should it be necessary to preserve the body a few days to allow
time for distant relatives to arrive, refrigeration or use of dry ice is
recommended, rather than embalming. Hindus do not bury their
dead, except infant children and godly saints

Matters of Birth

Hindus consider children a gift from God, and the conception, development
and birth of a child are sacred events, honored by a ceremony, or
samskara, marking these rites of passage. Today’s medical technology
has developed many means for conceiving children (and for their disposal
before birth). Hindus have a general unwillingness to interfere
with nature and a special aversion to abortion, based on the belief in
reincarnation and the sanctity of marriage.

From the Hindu point of view, conception connects a soul from the
next world to this world, and the state of mind at the moment of conception—
including the purity and spiritual intent of both partners—is
a major factor in determining who is born into the family. Prospective
parents often offer prayers at the temples, perform spiritual disciplines
and visit saints for their advice and blessings in their effort to conceive
a worthy child. In Western thinking, no emphasis is placed on the state
of mind of the parents at conception, and there is little understanding of
the ways parents can affect the “quality” of the souls born to them.

Birth Control
While revering conception as a divine act, Hindus have little hesitation
to practice birth control, and there are remedies specified in ayurveda
both for facilitating and preventing conception. Yes, as Swami Bua reminds
us, restraint and moderation are important: “Hindu scriptures
explain how to beget a child. They specify the days, time and methods.
That means they would have known also how not to beget a child! But
willful control of conception by external means was not advocated. The
preferred control was through restraint, as wasting of life seeds was
considered unhealthy and unethical. Birth control now is highlighted
as a prime duty of every citizen to the society and nation. But one fears
that these open discussions are licensing the society towards promiscuity,
since the weak minds take the shortest route to pleasures, however
fleeting they may be, unmindful of consequences.”

Sterility Testing
While ostensibly harmless, sterility tests can cause serious social and
emotional difficulty if one is deemed sterile, including inability to find
a spouse, cancellation of proposals and the ruin of marriages once it is
known “who is to blame” for the lack of children. “This should not be
resorted to as a routine test,” says Swami Bua. “Doubting the manliness
of a man and femininity of a woman is degrading them. What will happen
to those who fail the test? Will anybody come forward to marry
them? Even though procreation is the main aim of a marriage, it is not
the only aim. After a reasonable time following the marriage, if there
has been no conception, and if a mature couple desire to get tested with
a view to take corrective action, it may be done.” Dr. Sodhi points out
that, while ayurveda has no tests for sterility, the likelihood of children
is one of the major considerations when evaluating a couple’s astrology
prior to marriage.

Artificial Insemination
Fertilization of the egg by mechanical introduction of sperm is universally
acceptable when the sperm is provided by the woman’s husband.
But questions arise with donated sperm from another man. Because conception
creates a psychic bond between a man and a woman, even if
they don’t meet physically, fertilization in this manner may have a similar
karma as adultery. “In Sanatana Dharma initiation into married life
is sanctified by sacred sacramental rites,” says Swami Tejomayananda.
“The offspring of such a union is blessed and protected by the holy mantras
and rites. If there is some defect or obstruction in either partner, artificial
insemination may be resorted to, but with the husband’s sperm only.
If the procedure succeeds, it may be taken as the will of the Lord for that
couple. Use of seeds from the sperm banks or from any living person other
From conception to birth: (clockwise from top) A woman undergoes an
 than the husband is not proper. It will amount to bearing child outside
holy wedlock.” However, as Professor Crawford points out, the Manu
Dharma Shastra did allow a woman to conceive a child by another
man, usually her husband’s brother. Swami Bua mentions this tradition
also, “The Rig Veda and Atharva Veda prescribe the procedure called
niyoga to enable a childless widow or the wife of an impotent man to
raise progeny with his consent. But even with this, the attitude of an
average Hindu woman considers the one who has given her a child as
her respectful husband.” Satguru Bodhinatha Veylanswami points out
that one has to consider the likely negative impact of artificial insemination
on a marriage. The husband would not be the child’s true father,
resulting in a weak relationship with the child and even with the wife
who required another man to conceive the child.

In Vitro Fertilization
Even with present-day technology, the creation of “test-tube babies,”
the fertilization of the egg outside the womb and its subsequent
placement in the womb, is expensive and unreliable. As with artificial
insemination, it is acceptable if the egg and sperm are from the
husband and wife. Like other medical advances, in vitro fertilization
introduces unknown factors that may bring unintended consequences,
not necessarily positive or conducive to spiritual progress, which
is life’s real purpose. Hindus regard the natural way of things as endowed
with God’s infinite intelligence and often ask, “Are humans
wise enough to tinker with the cosmic order of life?”

Hindu scripture and tradition clearly prohibit abortion, except to
save the life of the mother. It is considered an act against rita (universal
order) and ahimsa (noninjury). In the words of Swami Omkarananda,
“Imagine, through millions of abortions around the world,
day in and day out, how many wonderful scientific and spiritual
doctors, men of excellence of every kind, sages, saints, benefactors
of mankind, builders of a better culture and civilization—
destroyed even before they can take a breath of fresh air here on
Earth!” Hindu ethics also do not justify aborting a fetus because of
actual or potential deformity or mental retardation, for each birth,
normal or not, is revered as having a divine purpose to be understood,
not manipulated. Nevertheless, abortion is performed today
by Hindus in India and elsewhere—in particular, the selective termination
of female fetuses following ultrasound examination. Professor
Crawford calls that practice “a perverted use of modern science, a
scarcely concealed form of female infanticide.” Gurudeva summarized
in sutra 34 of Living with Siva, “Followers know abortion is, by
Vedic injunction, a sinful act against dharma fraught with karmic
repercussions. Scripture only allows it to prevent the mother’s death,
for it is a greater sin for a child to kill the mother.” “In the modern
context,” says Swami Tejomayananda, “attention must be focused on
the prevention of pregnancy by educating and creating awareness in
the parents.” Abortion, should it occur, creates a karma to be faced
in the future, but is not regarded as an unforgivable “sin.” A penance
could mitigate the karma, such as adopting a baby who might otherwise
have been aborted if no home was provided.

Selective Termination of Multiple Fetuses
Multiple births are rare, except when a couple is undergoing fertility
treatments. These often result in multiple fetuses, creating a potentially
dangerous condition for the mother. Under the principle that
abortion is allowed to save the mother’s life, Dr. Sodhi believes that
selective abortion is acceptable when a specific pregnancy poses such
a threat. It is an unfortunate choice to have to make, and it is hoped
that future technology will reliably produce only one fetus.

Pain-Relief Drugs for Newborns
Pain relief for children should be carefully chosen to not form, or
lay the seeds for, a future addiction. Swami Bua says, “Some people
think that the pains of a newborn baby are the consequences
of its previous birth and that we should allow the baby to experience
and sustain them so that remnants of the previous birth are
left behind. But we should also realize that the God has brought
this baby to our hands expecting us to comfort it and protect it
and help it to grow as a healthy and worthy human being. So, it is
the duty of the parents and the people nearby to do whatever is
possible to relieve the baby of the pain.” “According to ayurveda,”
says Dr. Sodhi, “the baby has as sensitive a nervous system as an
adult, just not as developed. So pain medicine is okay, if necessary.
Morphine was used for thousands of years in the form of opium,
applied on the baby’s skin for pain relief.”
Hindus consider the practice of circumcision for males unnecessary
and do not practice it. Doctors should be alerted to Hindu
views on this often-standard procedure. A circumcised Hindu
boy could face ridicule and discrimination. In rare ocassions, the
procedure is required as a medical necessity for an adult, but is
kept secret.

Other Concerns
There are additional important ethical considerations regarding
organ transplant, blood transfusion, faith healing and dietary laws.

Organ Transplants
Hindus generally believe that the recipient of a major organ, such
as the heart, liver or kidney, takes on some of the karmas of the
donor. Evidence of this transfer of karma can be found in documented
cases where the organ recipients took on the interests,
emotions, food preferences, etc., of the donor, especially after a
heart transplant. Transplants apparently create psychic connections
with the donor, whether living or dead. Also, the fact that
part of a deceased donor’s physical body still “lives” may interfere
with his reincarnation pattern, keeping him close to the physical
plane and to the recipient. Swami Tejomayananda offers, “The
Hindu way of life is to accept the inevitable, to go through the
karma, exhaust it and be free to take on new life to evolve further
spiritually.” Swami Bua is supportive. “Let us encourage and support
the scientists and medical men who are working with pure
intentions towards a painless, diseaseless society. We should only
guard against unscrupulous traders in human organs.” Swami
Chidanand Saraswati (Muniji) feels that it is “important to donate
organs” in the Hindu spirit of giving and sacrifice. Dr. Sodhi offers:
“Some transplants, such as the cornea, are okay, but not the heart,
which is the seat of the soul according to ayurveda. If the quality
of life is going to be very good after the transplant, I might not
have a problem, but if they have to be on harsh drugs all the time,
maybe transplanting is not the best idea.” Swami Satchidananda
says “What are we doing by transplanting organs? By replacing
organs in a body which is clearly dying, we are not allowing the
soul to fulfill its karma in this life by dying at the proper time and
getting a new body. The trend of science seems to want to keep
the soul indefinitely in the same old body with repaired parts.
This is not the correct thing to do.”

Blood Donations/Transfusions
“In early times there were some hesitations on the basis of caste
and religion, for blood transfusion,” says Swami Bua, “But now,
considering the necessity of blood transfusion during any surgery,
people are accepting it.” Blood transfusions differ from organ donations
in that the body of the recipient completely replaces the
foreign blood.

Religious or Faith Healings
Hindus make use of all means of healing, be they medical, astrological
or metaphysical. The last includes mantras and yoga,
seeking the guidance of a guru or performing temple ceremonies
for the direct blessing and intervention of God, Gods and devas.
“A Hindu has an ardent faith in the powers of prayers and in the
Supreme God,” says Swami Bua, “The patient will go to the doctor—
ayurvedic or allopathic—all the while praying to God for
recovery.” “Healing with mantras was very popular in ancient
times.” says Swami Pragyanand,
“Even now it is being practiced
for various ailments.” Swami Tejomayananda notes, “In healing
by prayers, Divine Grace comes in. If the karma is nearing exhaustion,
or it is only a weak karma, or the healing will help the
person in his spiritual pursuit, or if the Higher Power has some
work to be done through the person, then a cure may be effected.”
Dr. Sodhi adds, “In ayurveda, specific pujas, or ceremonies to the
Gods, are sometimes prescribed for patients.”

Dietary Ethics
Yes, vegetarianism is a central aspect of Hinduism, and of even
broader import is the ayurvedic wisdom that health is directly
dependent upon diet. A Hindu vegetarian who is hospitalized will
need to coordinate with the staff to be served proper food unless
he can have family or friends bring his meals. The ayurvedic prerogative
is to eat a diet that prevents disease and enhances spiritual
life. When ill, a drastic change in diet may be the best cure,
as seen in the improvement of heart patients put on a vegetarian
diet. “The scriptures recognize the fact that food has a great influence
on the mind,” says Swami Tejomayananda, “‘When food is
pure, mind is pure,’ state the Upanishads. Mothers prepare food
with love in the heart for the children. These positive vibrations
are absorbed and the persons who partake of the food imbibe
them. Eating is an act of worship.”
There remain several areas of concern in medical ethics which
will be addressed in future articles in Hinduism Today, including
genetic engineering, genetic testing, stem-cell research, cloning
and animal to human transplants


Om Tat Sat

(My humble salutations to Sadguru Sri Sivaya Subramuniyaswami ji, Hinduism Today  dot com  for the collection)

(The Blog  is reverently for all the seekers of truth, lovers of wisdom and   to share the Hindu Dharma with others on the spiritual path and also this is purely  a non-commercial)


Post a Comment