Hi everyone,
I was just reading some articles on yahoo.com about Terri Schiavo including one about the perspectives of various faiths. To summarize, Terri Schiavo had an eating disorder which causes her to have a heart attack which cut off blood to her brain and resulted in what court appointed doctors call a "persistent vegetative state" with no hope of recovery. She can breathe on her own, but her mind is gone, and she must receive artifical nutrients and water. Her parents, practicing Roman Catholics, insist that she does respond to them, but doctors say these are only "reflexive." She has been in this state for 15 years and her husband does not believe she would want to be kept alive artificially in this way and has decided to have the feeding tube removed. Her parents are fighting in the courts to get it reinserted and even the president has gotten involved.
The pope has decared it morally obligatory to provide sustenance to those with brain damage in this condition. In fact, the Catholic Church declares the removal of the feeding tube in this case as "euthanasia by omission." A Muslim scholar said that it is also obligatory to provide food and water but no other extraordinary means. Jewish rabbis have various opinions - some seeing artificial feeding for this long a period with no hope of recovery as an "extraordinary means" while others see it as meeting a basic need for those who can't care for themselves.
I wondered how I, as a Buddhist minister, would respond if I had been asked about the morality of this case. To begin with, Buddhism is also unequivocally against abortion, the death penalty, and euthanasia. This is evident in the first precept for monastics which specifies that killing in the case of this precept covers the death of anyone from the moment of conception all the way up to fatal diseases. One must not condone, encourage, or participate in the killing of other human beings (this precept does not cover the killing of animals which is a lesser offense in the Buddhist monastic code). Aside from this precept there are suttas wherein the Buddha condemns those who "use the knife" to kill themselves when faced with a fatal illness and also saves the serial killer Angulimala from capital punishment.
But the trick is this - what are basic needs that should be met, and what are extraordinary means of keeping a person alive who it is time to let go of? Active means of bringing about the death of a person who is fatally ill or in a coma or persistent vegetative state is indeed ruled out. But what about keeping someone alive when they should be allowed to die naturally with dignity. Where is the line between caring for those who can't care for themselves (like a baby or a bedridden person) and keeping someone alive artificially which is a form of clinging and attachment? There are no clear cut answers in the Buddhist canon that I am aware of.
In pre-modern times, before feeding tubes and such things, this would not have been an issue. I think we need to be clear that we are using our advanced technology to keep this woman alive. This is no longer a truly natural process that we are dealing with. On the other hand, it strikes me that the doctors dismissal of Terri's responses to her parents as "reflexive" may be a reduction of the human person to just what can be measured by materialistic science. I think they are claiming more knowledge than they really have. On the other hand, Terri's parent's may be deluded and clinging to an empty shell. There really don't seem to be any easy answers here.
The Buddhist way of viewing a people is to view them in terms of five mutually supportive and interactive processes - form, sensation, perception, volition, and consciousness. But Buddhist Abhidharma does admit of states wherein there is consciousness but no form, or form but no consciousness or at least not any discernible consciousness. In any case, consciousness can be present but so subtle that it is no longer measurable and no longer even produces subjective or self-aware experience. And of course even vegetables and plants are alive. If someone is in a "vegetative" state that does not mean there is no life there. Neither is it necessarily keeping someone locked into a state of suffering. We don't really know what, if any, subjective state someone like Terri may be in. But from a faith perspective, in Nichiren Buddhism we teach that even grasses and trees have the buddhanature. I fully admit that is Mahayana hyperbolic rhetoric, but there is a concrete truth to it. That truth is that all life - even non-self-aware life has a dignity and an ability to manifest buddhanature. In other words, there is a quality there worth caring for and preserving. So if I look at it from that angle, then compassion does demand that we provide care, food, drink, and nourishment if we are able to all forms of life - even life that is not or has ceased to be self-aware and/or autonomous.
But then what about all the people wandering the streets of our cities who are self-aware but are crippled by mental illness and other forms of social maladjustement, addictions, and in some cases various forms of trauma that are in fact not their own fault (I do believe there are some few cases where people are homeless and it is not in fact "their own damn fault")? Why are they allowed to starve to death, freeze to death, die of exposure, be murdered with impunity (in some cases), and to go into seizures or whatever because they are being denied proper medical care. Every couple of weeks or so there are new names on the Buddhist altar at the Faithful Fools Zendo with new names of homeless people who have died on the streets. Why is this form of euthanasia acceptable to our president, to our society?
From a Buddhist perspective, euthanasia is never ok, whether actively or by omission, whether it is to someone bedridden in a persistent vegetative state or someone being allowed to die on the sidewalk in front of our churches. Extraordinary means do not need to be used, most people agree on that. But basic food, water, shelter, and medical care is not extaordinary, but a basic obligation of human dignity.
Perhaps someone who needs to receive food and water through technological devices is being kept alive by extraordinary means. But perhaps not. But there are people dying who are not vegetative but mentally ill and/or maladjusted and/or incorrigible, but does that make it ok to kill them by denying their existence? It mystifies me that a woman who has been a vegetable for 15 years gets the attention of the president, whereas there are actually people dying in the streets who are actively encouraged to die. From the Nichiren Buddhist point of view even the incorrigible slanderers against the Dharma also have buddhanature and will someday (in this or another lifetime) attain buddhahood - so even their dignity should be recognized. Even they should receive basic food, water, shelter, and nutrition.
This is not impossible. I did not see any homeless people in Copehnhagen. That does not mean there are not any. But it was not like here. So much of this hysteria over the rights of a woman in a persistent vegetative state for 15 years rings false to me when I see new name cards on the altar. But make no mistake, I agree that euthanasia by action or omission is wrong from a Buddhist point of view, and particularly a Nichiren Buddhist point of view.
So those are my thoughts about the issue of euthanasia.
Namu Myoho Renge Kyo,
Ryuei
I think this poor woman should be allowed to die with dignity. Not just kept around for the selfish reasons of her family. What value of life does this woman have? She's been a prisoner of her body now for 15 years. If anyone really cares about her welfare then let nature take it course and let he be free.
Posted by: Joe at March 22, 2005 10:21 AMWhatis "Life" anyway? Doesn't seem to me as thought she has much of one. And what kind of a visious deity would want a person to continue in such a state?
I remember back when I first started chanitng, A dear aunt of mine asked me to help her end her life. She was in a lot of pain from throat cancer, and wanted to take a "cocktail" - I agreed to help her, and then started thinking about what I had promised. Well, I didn't want to give her that cocktail without being able to say I had done all I could for her, so I ended up chanting about 36 hours in one week. She turned around and lived for another six years, even taking a trip to Europe with my mother. Don't know what the message is there... the closest I have to a Nichiren Buddhist take on euthanasia. BEst, Byrd in LA
Posted by: Byrd in LA at March 22, 2005 03:29 PMAt the risk of being flamed, I have to say that "dying naturally" in a case such of this means dying of starvation and thirst. We have no way of knowing whether a person in a coma feels hunger/thirst, and they cannot tell us. Certainly for a conscious person, dying in this manner is terrible, lingering death.
One thing people who have awakened from long term comas have said is that there is a degree of awareness, hearing, sometimes even sight. There is something arrogant about assumption that the only consciousness worth experiencing is the one that is "normal." When we dream at night, do we question the "realness" of that experience while we are in it?
Posted by: titania at March 22, 2005 05:16 PM"Buddhism is also unequivocally against abortion, the death penalty, and euthanasia." Although I mostly agree, there are many Buddhists who will strongly take issue with this declaration or rather, you making this declaration on their behalf. Believe me, I have been vilified in person by other Buddhists for saying the same thing.
Be that as it may, if this woman is at all aware, then starving to death would be truly horrifying. OTOH, living as she does for 15 years would be horrifying to most of us who are aware.
I don't have the answer. But I don't think it is correct to say she is being kept alive by "non-natural" means. For one thing, we are all kept alive by non-natural means. For another, those means are a perfectly natural result of Man's natural ability to use tools. Perhaps what is most instructive is that these means have resulted in situations we as a species just aren't ready to deal with spiritually yet.
It's a tough choice, and I'm glad I'm not in the husband's or the family's shoes. You're right in that religion should at least try to provide an answer. A black-and-white one like the Catholics provide is easiest. Maybe they are onto something there ;-).
Posted by: John at March 23, 2005 01:17 PMRyuei:
Right to life issues can be very emotional. Prior to chemotherapy, I had to make some serious decisions on the use of extraordinary measures to save my life, if need be - like the use of a ventilator, heroic measures, etc. Although my wife (now ex) was upset, I made it very clear that there should be no life heroic measures taken, so I would not be a burden on my loved ones. I was also confident enough in the eternity of life that death to me was like changing my clothes. I still remember being hooked up to all these monitors which two physicians standing by prior to a test dose of one powerful drug, because it was known to cause acute cardiac arrest. I chanted three times, told them to begin. In my mind, I was ready to die.
Which brings us to this poor woman and her family. I am loathe to put stock or absolute confidence in literal interpretations of Buddhist or any other religious proclamations on life or death that are thousands of years old. This woman is a vegetable who can't feed herself, can't clean herself, and is little more than a mass of cells with an eclipsed consciousness. It's true that the Catholic see such issues in black and white, but we live in a world of living color. I am with the husband on this one. This woman should be allowed to fade away. Having seen my own mother die if starvation in a hospice setting due to throat cancer, I can tell you that starvation is not pretty. But here's a news flash for those who rail against the pain and horrible death of starvation. Most every death is a brutal, grueling affair. The idea of being surrounded by loved ones while we slowly expire brings a tear to the eye, but is usually far from the reality of the nearly 100 deaths that I have personally witnessed. We all aspire to that stoic, glorious and victorious death, but death comes all the same anyway it comes. Death from starvation and of thirst causes the brain to go into death mode flooding the body and mind with endorphins. There are worse ways to go.
Although we would all prefer that this woman have a miracle - it's not going to happen. Death for her will be a blessing rather than the wretched existence she has now. Her parents are so attached to what was their daughter that they have lost all perspective. If it was my own life, my mother, or my own daughter, I'd pull the plug myself.
Charles
Posted by: Charles at March 23, 2005 02:24 PMA difficult and a sensitive subject for which there are no easy answers...
How can we as Buddhists condone taking life?
Yet keeping someone artificially alive with no quality to that life is also un natural.
Because these people in question here are not Buddhists (as far as I know) they can not respond to their situation from a buddhist point of view. They can not act in the way as a Buddhist (well I only know Nichiren Shoshu) would in a situation when someone is dying. It is imperative not to disturb the person and not to take any action to cause them to feel attachement. They should not be touched physically at all. The environment must be calm. Water should be only dripped through a cotton bud on their lips etc etc...
It is complicated and hard enough for Buddhists never mind people who can not understand why the attachement and expressions of that by those present are very dangerous at the point of death.
It is my understanding that we must never take life. Is it taking life to switch off support?
I just don't know.
Naturally one does not wish this person to have to continue suffering.
But then again we do not know if the mind is working and clear.
To assist in taking life is wrong in the light of Buddhism definately. I recall advise from one of our Priests that even animals should not be "put down" (something I had been forced to go through with my cat previously when I was in SGI and I never got over the feeling when they made me sign the from assenting to it...eventhough I did not want to do it. They just pressed on and on that I must agree and I gave in...15 years later I am still apologising for that during my memorial Gongyo for him...)
Jussi.
Having spent much time working in the medical field repairing those CT scanners that took those wonderful images of Mrs. Schiavo's brain and having worked with the radiologists who interpret those scans so that I could repair said scanners back to where the images were back to where the radiologists liked them, I can tell you that in the hospital where I used to work, we had a patient who's scan was similar to Terri's (only there was just a bit MORE grey in it). This patient, however, was in the same condition that Terri Schiavo was, the difference being that they had their living will (advance directives - DNR orders) all signed, sealed, and delivered, with all the "i's" dotted and "t's" crossed. But I can also tell you that it is not a "coma" that we are talking about in this case. You cannot "regrow" brain tissue - thoses black spaces will never fill in and there is not enough grey matter left to take over learning what the black spaces once knew. Plants at least turn toward the light - you set the plant next to the window and the leaves grow toward the sun, so you turn it around and they grow the other direction. But this person we had in the hospital, well you could shine one of those little pocket penlights directly in their eyes and move it back and forth but they would not follow its movement. Autonomic nervous system - what the brain stem controls - breathing, heartbeat, those sort of things - but you could also have shined that flashlight into that patients eyes long enough to have blinded them and they would not have turned away. What kind of quality of life is that?
Also, there's something to be said about that thing when daddy 'gives the bride away' at the wedding. Seems to me that a wife's husband knows a little something about what her wishes for end of life scenerios would be. I mean really, are the parents there in those intimate bedroom discussions that husbands and wives have after watching this stuff in movies or hearing about it on TV? I'm sorry, but I just don't think my parents or my siblings have rights in my healthcare decisions.
Maybe it's just me, but after what I have seen during my stint in Desert Storm and all the time working in the hospital and Scotty's time working as a nurse, I'm really glad he knows my wishes and I know his and we both have our living wills/advance directives/power of attorney for healthcare/DNR orders all in order.
As always, all my opinions only. Like has been said, these topics are emotional and no one will ever agree :) DONNA
Posted by: MonstrousEgotist at April 4, 2005 08:35 AM