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
Saraswati
(Muniji), Swami Omkarananda,
Swami Pragyanand,
Swami
Tejomayananda
of Chinmaya Mission, Satguru Sivaya
Subramuniyaswami
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
principle
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
ideal.
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.
Suicide
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
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.
Conception
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?”
Abortion
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
geniuses—
doctors, men of excellence of every kind,
sages, saints, benefactors
of mankind, builders of a better culture and
civilization—
are
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.”
Circumcision
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
(Continued...)
(My
humble salutations to Sadguru Sri Sivaya
Subramuniyaswami
ji, Hinduism Today dot com for the collection)
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