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Medical Ethics
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Hindu medicine, known as ayurveda or 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 to 34 areas and wanted to include the views of Hinduism and
Buddhism to accommodate increased religious diversity among their patients.
To respond to their request, Hinduism Today enlisted the help of Swami Bua of
New York (healthy today at age 115); Swami Satchidananda of the Integral Yoga
Institute; Swami Ranganathananda, president of the Ramakrishna Mission; Swami
Chidananda Saraswati (Muniji); Swami Omkarananda; Swami Pragyanand; Swami
Tejomayananda of Chinmaya Mission; Satguru Sivaya Subramuniyaswami, founder of
Hinduism Today and his successor, Satguru Bodhinatha Veylanswami. We also
consulted with Dr. Virendra Sodhi, a gifted ayurvedic and allopathic doctor in
Washington, and Cromwell Crawford of the University of Hawaii, an Indian-born
specialist in Hindu medical ethics. The assembled responses below represent the
broad consensus of this group, with occasional differing opinions, though the
precise wording has been crafted by Hinduism Today. 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 overarching 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.
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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 yogaseeking 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 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 struggle-filled 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. Knowing his intentions
would alleviate 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 "near-death 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.
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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 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
elsewhereparticularly 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, which may result in multiple fetuses, creating a potentially
dangerous condition for the mother. Under the principle that abortion is
allowed to save the mothers 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 hopefully future technology will reliably produce
only one fetus.
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
Chidananda 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
doctorayurvedic or allopathicall 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.
When healthy, the 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 when put on a vegatarian
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
Upnaishads. Motheres 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."
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