Voluntary Euthanasia

General discussion of issues related to Theravada Training of Sila, the Five Precepts (Pañcasikkhāpada), and Eightfold Ethical Conduct (Aṭṭhasīla).

Voluntary Euthanasia

Postby Ben » Wed Oct 16, 2013 9:48 am

The Lower House of the Tasmanian State Parliament is tonight debating a private member's bill on euthanasia (voluntary assisted dying). The bill was drafted by Tasmanian Premier, Lara Giddings and Deputy Premier, Nick McKim. A private member's bill is where the parliamentarians are allowed to have a 'conscience vote' rather than be constrained to vote along party lines.
Local commentators expect the legislation will not be passed despite the fact that over 80 percent of the Tasmanian community support the proposed legislation.
For me, the issue raises some difficult ethical questions and a hope that I won't have to face making a decision like this again.
But, what are your thoughts? How do you negotiate the ethical issues associated with either supporting or not supporting voluntary euthanasia?
kind regards,

Ben
Learn this from the waters:
in mountain clefts and chasms,
loud gush the streamlets,
but great rivers flow silently.

Taṃ nadīhi vijānātha:
sobbhesu padaresu ca,
saṇantā yanti kusobbhā,
tuṇhīyanti mahodadhī.

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Re: Voluntary Euthanasia

Postby Sanjay PS » Wed Oct 16, 2013 12:59 pm

These are very difficult conducts which have no easy straightforward thoughts which can set forth a policy .

Being a worldling and unripe in Dhamma , i think i may not be a capable person to clearly see through this dilemma . On a personal front i would not encourage euthanasia , and please forgive me for going off-topic and narrating a personal happening . Quite a few years ago my Mother was diagonized with colon cancer , and doctors conveyed to me that she had at the most 2 months to live . My father being a doctor himself, and having battled oral cancer, was keen on aggresive chemotherapy , however , my mother was not in favor at all . The top cancer specialist in our country with 5 decades of experience , saw her case sheet, and opined that palliative care was the only sensible recourse .

Pain , just like pithi , can not be comprehended . It was tough, there were times when i had no choice but to inject morphine myself . All the best of pain swatches and patches would just not help her . i am grateful that she did a 10 day course on my request , prior to the intense pain that set in and the debilitation began . Also , i am so grateful to the very kind teacher conducting the course, in compassionately not allowing me and my mother to be together during the course , although it was clear that she would need a dedicated volunteer to serve her during the course period ( the course was already short of volunteers) . Just when i had resigned to fate and we were exiting the centre , we were called back . At that moment there was an elderly gentleman with alzheimers who had come to attend the course along with his daughter , the teacher made us switch places .It was with great delight and enthusiasm that i took upon the serving the elderly man . It was one of my finest service courses done yet . The elderly man gave me a hard time , and threatened that he would jump the wall when i was asleep and escape . Once he locked me out in the night after i came back after the night metta session , saying that he would not tolerate late comers ! ( he was an old student , who done a course under Goenkaji in Dhammagiri ). Another time he was nowhere to be found in the centre , after the morning meditation period of 4 to 6:30 a.m, ( the night before he had firmly decided to leave , and did not even listen to the gentle requests of the teacher, and commanded us that his daughter be conveyed that she should arrange for a cab the next morning , or he would leave on his own ), my heart sank . Lastly when i thought of checking the now empty Dhamma hall , i saw a single pair of footwear outside , which was his , gently i went in , Goenkajis chant, played after the breakfast bell was going on , and this gentleman was ardently meditating . i knew that he would no longer need the taxi now , and i quietly sat behind him and meditated along . When he clambered to rise up , i gave a hand , he was surprised , and mentioned that he would no longer require the taxi :) It was such a strong moment that got etched itself in my mind, probably for a few life times.......

My mother went on to live for 11 months , and left me a will which i did not deserve, writing that she would want to meet up with me again in whatever form in her successive lives . i was fortunate to gently hold her palm in my hands , and lie besides her, meditating with arising and passing , knowing that she would not see through the night . She did not get to see her two grand children being born, for which i have no regrets . Happiness can never be found by any material or familial comforts , all such ease are short lived , giving us a false sense of relief .

Coming back to Voluntary Euthanasia , i have read in the Manual of Dhamma , authored by the Venerable Ledi Sayadaw , that the remainder of kamma , is bound to catch up , and it just spills over ..........

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Re: Voluntary Euthanasia

Postby dagon » Wed Oct 16, 2013 1:42 pm

information about the proposal - In part

As legislators we believe that the law in this area has not kept up with changes in medical practice, social values or the views of the vast majority of the community. It is time for change.

We believe it is important and necessary for the Parliament to enact legislation that fully demonstrates the compassion we all feel for people who are suffering in extremely difficult circumstances at the end of their lives. We know of too many terrible experiences for people at the end of their lives who have not found current care and treatment options to be effective and who have clearly and voluntarily expressed a wish to have their suffering cut short, even if it hastens their death. We do not believe it is acceptable to allow the current situation to continue when there are such substantial negative effects for those patients who are dying in prolonged suffering that cannot be relieved adequately and for whom there are no other effective care or treatment options.


http://www.premier.tas.gov.au/__data/as ... smania.pdf

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Re: Voluntary Euthanasia

Postby David N. Snyder » Wed Oct 16, 2013 3:37 pm

It's definitely a difficult issue, for Buddhists and non-Buddhists. There are thoughts and feelings of ahimsa and compassion on both sides of the issue.

Buddhism, like Jainism is opposed to all killing of any sentient being. However, how can we let someone just wither away in agony, in excruciating pain, especially if the illness is terminal, no chance for survival and full of pain and suffering. I used to think that the Buddha-Dhamma was completely opposed to all forms of euthanasia, but now I am not so sure. The Buddha obviously had compassion for all beings and did not want to see them suffer. He was not opposed and did not forbid medicine. He and Ananda assisted a sick monk, caring for the ill monk.

There is the case of Ven. Channa and others in the Suttas which I have posted in other threads on this subject, who took his life and was an arahant.

In the Channovada Sutta (MN 144), Venerable Channa is sick, in pain and uses 'uses the knife.'

The Commentaries take the position that Ven. Channa was a noble level monk, but not yet an arahant. As he was dying he was able to realize the truth and attain full enlightenment. However, the scholar monk Bhikkhu Bodhi disagrees and has written. "It should be noted that this commentarial interpretation is imposed on the text from the outside, as it were. If one sticks to the actual wording of the text it seems that Channa was already an arahant when he made his declaration [earlier in the Sutta Channa says: 'I will use the knife blamelessly'], the dramatic punch being delivered by the failure of his two brother-monks to recognise this. The implication, of course, is that excruciating pain might motivate even an arahant to take his own life; not from aversion but simply from a wish to be free from unbearable pain." (Bhikkhu Bodhi, trans. Middle Length Discourses of the Buddha, 2001, 2nd ed. 1359 n1312)

When performed, euthanasia is to relieve the suffering for oneself or another. I still have not heard any point made in any of the several threads we have on this subject about how euthanasia has any dosa in it? How does euthanasia have dosa? And "aversion" doesn't count, because where is the aversion? Aversion to suffering? Then, any wholesome act could be called aversion, which is just a cynical-pointless answer. For anyone who is completely opposed to euthanasia in all circumstances, please show me where the dosa is?
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Re: Voluntary Euthanasia

Postby Mr Man » Wed Oct 16, 2013 4:25 pm

In my opinion euthanasia clearly does not correlate with the most fundamental of Buddhist teachings the four noble truths. Possibly we can find justification for or acceptance of euthanasia but that justification/acceptance is apart from the Buddha's teaching. I can't buy the idea that one can kill with a pure mind state but can accept the idea that sometimes we have to do things which might not be ideal and accept the consequences.
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Re: Voluntary Euthanasia

Postby Sanjay PS » Wed Oct 16, 2013 4:27 pm

David N. Snyder wrote:It's definitely a difficult issue, for Buddhists and non-Buddhists. There are thoughts and feelings of ahimsa and compassion on both sides of the issue.

Buddhism, like Jainism is opposed to all killing of any sentient being. However, how can we let someone just wither away in agony, in excruciating pain, especially if the illness is terminal, no chance for survival and full of pain and suffering. I used to think that the Buddha-Dhamma was completely opposed to all forms of euthanasia, but now I am not so sure. The Buddha obviously had compassion for all beings and did not want to see them suffer. He was not opposed and did not forbid medicine. He and Ananda assisted a sick monk, caring for the ill monk.

There is the case of Ven. Channa and others in the Suttas which I have posted in other threads on this subject, who took his life and was an arahant.

In the Channovada Sutta (MN 144), Venerable Channa is sick, in pain and uses 'uses the knife.'

The Commentaries take the position that Ven. Channa was a noble level monk, but not yet an arahant. As he was dying he was able to realize the truth and attain full enlightenment. However, the scholar monk Bhikkhu Bodhi disagrees and has written. "It should be noted that this commentarial interpretation is imposed on the text from the outside, as it were. If one sticks to the actual wording of the text it seems that Channa was already an arahant when he made his declaration [earlier in the Sutta Channa says: 'I will use the knife blamelessly'], the dramatic punch being delivered by the failure of his two brother-monks to recognise this. The implication, of course, is that excruciating pain might motivate even an arahant to take his own life; not from aversion but simply from a wish to be free from unbearable pain." (Bhikkhu Bodhi, trans. Middle Length Discourses of the Buddha, 2001, 2nd ed. 1359 n1312)

When performed, euthanasia is to relieve the suffering for oneself or another. I still have not heard any point made in any of the several threads we have on this subject about how euthanasia has any dosa in it? How does euthanasia have dosa? And "aversion" doesn't count, because where is the aversion? Aversion to suffering? Then, any wholesome act could be called aversion, which is just a cynical-pointless answer. For anyone who is completely opposed to euthanasia in all circumstances, please show me where the dosa is?



Euthanasia out compassion , will have no aversion as a mental content in it . Most i think will agree on it . Its only when we become Arhants , will be able to answer the question from all its angles . Say for example , if there is a time period of intense suffering that a being is undergoing , and ending its life , will only mean the remainder to be pushed. Then a good dhamma environment , along with care , may be the best suitable , because successive lives may or may not foster a dhamma atmosphere . i don't know, so i may well be wrong on this.

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Re: Voluntary Euthanasia

Postby robertk » Wed Oct 16, 2013 5:46 pm

David N. Snyder wrote:It's definitely a difficult issue, for Buddhi
In the Channovada Sutta (MN 144), Venerable Channa is sick, in pain and uses 'uses the knife.'

The Commentaries take the position that Ven. Channa was a noble level monk, but not yet an arahant. As he was dying he was able to realize the truth and attain full enlightenment.

-pointless answer. For anyone who is completely opposed to euthanasia in all circumstances, please show me where the dosa is?


the commentary says he was a putthujhana and attained all stages after cutting his throat.
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Re: Voluntary Euthanasia

Postby David N. Snyder » Wed Oct 16, 2013 5:48 pm

Hi Robert,

I know, but see Bhikkhu Bodhi's comments in my post above. Bhikkhu Bodhi disagrees and suggests that he was an arahant before cutting.
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Re: Voluntary Euthanasia

Postby Bhikkhu Pesala » Wed Oct 16, 2013 6:00 pm

If there is no ill-will or aversion (dosa), i.e. if one is a Non-returner or an Arahant, then the pain won't be unbearable.

21. And soon after the Blessed One had eaten the meal provided by Cunda the metalworker, a dire sickness fell upon him, even dysentery, and he suffered sharp and deadly pains. But the Blessed One endured them mindfully, clearly comprehending and unperturbed.
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Re: Voluntary Euthanasia

Postby Anagarika » Wed Oct 16, 2013 8:42 pm

There is the dogmatic position on euthanasia (any volitional ending of life is forbidden) and there there is the approach that utilizes wisdom, ethics and compassion. I recall Bhikkhu Bodhi discussing the issue of Bhikkhuni ordination. THere were many positions taken on this issue drawn from the Suttas and the Vinaya. Teachers that I greatly respect took opposing positions on the issue of Bhikkhuni ordinations. At the end of the day, Bhikkhu Bodhi said something ( I am paraphrasing) that I think is relevant in the context of euthanasia..."when in doubt, take the compassionate path."

To any of us who have been close to the death experience, we know that the end of life is often not very 'sacred.' I'm in a hospice training now, and one of the trainings involved the phases of active dying. There can be extreme pain, fear, delusions, PTSD symptoms emerge in war veterans, terror over breathing, and just the process of death by say, aggressive cancer is very ugly. Palliative measures include heavy doses of morphine, which sometimes do not keep the sufferer out of pain.

In some cases, where death is inevitable and significant pain and wasting of the body is certain, it may be wise, ethical and compassionate to determine that the path of life is ended, and that no just cause exists for the body to waste and suffer further. Intervention with euthanasia in some cases may be very beneficial for the patient and their family alike.

I am unsure of where the Dhamma scholars weigh in on the issue of euthanasia, but my unscholarly sense is that in the correct circumstances, it may be the most Buddhist thing to do. I'm willing to accept whatever kamma is involved in this kind of ethical intervention, in the right case.
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Re: Voluntary Euthanasia

Postby nibbuti » Wed Oct 16, 2013 10:15 pm

what are your thoughts? How do you negotiate the ethical issues associated with either supporting or not supporting voluntary euthanasia?


Hi.

Not sure what 'voluntary' here is (and what involuntary euthanasia might look like). But everyone talks about euthanasia out of compassion. What about the potential for abuse in killing-for-whatever-reason. If one accepts euthanasia, one has to face the fact that there would most certainly occur:

- fake euthanasia by greedy heirs.
- denial of medical help to save $$ under the guise of euthanasia.
- socially motivated euthanasia (like seppuku)
etc

In the end of the day, euthanasia is still the ending of a life, taking a life, however well meant and beneficial we might imagine or feel it to be.

On the other hand, there is the Other Extreme™. My grandpa's dukkha was unnaturally prolonged by machines for weeks, because the doctors honestly admitted they were afraid of the legal consequences if they turned them off.

Perhaps, it is better to accept there is dukkha, even with legal, moral and emotional shortcuts.

:shrug:
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Re: Voluntary Euthanasia

Postby tiltbillings » Wed Oct 16, 2013 10:22 pm

nibbuti wrote:
what are your thoughts? How do you negotiate the ethical issues associated with either supporting or not supporting voluntary euthanasia?


Hi.

Not sure what 'voluntary' here is, but everyone talks about euthanasia out of compassion. What about the potential for abuse in killing-for-whatever-reason. If one accepts euthanasia, one has to face the fact that there would most certainly occur:

- fake euthanasia by greedy heirs.
- denial of medical help to save $$ under the guise of euthanasia.
- socially motivated euthanasia (like seppuku)
etc

In the end of the day, euthanasia is still the ending of a life, taking a life, however well meant and beneficial we might imagine or feel it to be.

On the other hand, there is the Other Extreme™. My grandpa's dukkha was unnaturally prolonged by machines for weeks, because the doctors honestly admitted they were afraid of the legal consequences if they turned them off.

Perhaps, it is better to accept there is dukkha, even with legal, moral and emotional shortcuts.

:shrug:
Okay. So, there is never, ever a basis for euthanasia. The person who is in intractable pain, increasing out of control of his body, being subjected to mind numbing drugs, despite their wishes, must stay alive to die a natural, though prolonged, miserable death.
This being is bound to samsara, kamma is his means for going beyond.
SN I, 38.

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Re: Voluntary Euthanasia

Postby nibbuti » Wed Oct 16, 2013 10:43 pm

Okay. So, there is never, ever a basis for euthanasia. The person who is in intractable pain, increasing out of control of his body, being subjected to mind numbing drugs, despite their wishes, must stay alive to die a natural, though prolonged, miserable death.


No need to tilt.

The question that comes up with euthanasia is usually not a dramatized "patient must stay alive at all cost" type question, but rather more sober "should we keep the machines on or turn them off?".

One already existing measure (life-prolonging machines or medicine) can be used wisely, rather than adding another unwisely.

The other form of euthanasia, where someone actively shortcuts a terminal illness, like Channa, will happen whether 'I' support it or not. Death & dukkha do happen, whether 'I' want it or not.

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Re: Voluntary Euthanasia

Postby daverupa » Wed Oct 16, 2013 10:58 pm

Two Decades of Research on Euthanasia from the Netherlands. What Have We Learnt and What Questions Remain?

Abstract

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life.
    "And how is it, bhikkhus, that by protecting oneself one protects others? By the pursuit, development, and cultivation of the four establishments of mindfulness. It is in such a way that by protecting oneself one protects others.

    "And how is it, bhikkhus, that by protecting others one protects oneself? By patience, harmlessness, goodwill, and sympathy. It is in such a way that by protecting others one protects oneself.
- Sedaka Sutta [SN 47.19]
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Re: Voluntary Euthanasia

Postby dagon » Wed Oct 16, 2013 11:17 pm

Hi All

The existing legislative framework in most of Australia is that taking someone’s life intentionally is murder. Traditionally the medical profession has had the stated goal of extending life. The grey area where most end of life care “lives’ in is the palliative care model where treatment can be given to relive the symptoms with a view to quality of life rather than a goal of extending life. Those involved in such care can be threading a very fine legal line at times.

For me the ethical dilemma is that I do not believe that generally the teachings allow for the intentional ending of a life, yet at the same time deliberately causing suffering is not supported. What we need is to find a way in which these two considerations can be balanced within an ethical framework that meets the particular circumstances of the individual.
I would argue that in the developed countries and increasingly in other countries most people’s lives are extended beyond their natural lifespan by the intervention of medicine. We have the potential to extend “life” and suffering beyond what would naturally occur. Generally we have the right to refuse our consent to any individual medical procedure without losing the right to continue any other treatment.

Where we get beyond the point where we can exercise our rights, that right passes to our next of kin or those holding out power of attorney. While in many legal jurisdictions there are “living wills”, “end of life” paperwork …. Most of these are not legally binding and can be overridden by next of kin. In my view this is an area where legislative intervention could be much improved. The reality is that “greedy relatives” are far outnumbered by overly attached relatives who keep parents and spouses alive against their will – I have been guilty of this very thing.

Most of the patients that I have worked with when they have got closer to death have said that they want to die. I have NEVER been told by any of my patients that “I don’t want to die”.

Ethically, as members of societies we need to accept that if we have a legislative frame work that denies the individual the right to end their own life then we have an ethical obligation to ensure that those suffering have the legal, financial and practical access to services that minimize the suffering. The services that can help in this regard extend far beyond that provided in medical models.

In the last 8 weeks I have said the finally goodbye to 6 friends who I had looked after on a daily basis for between 1 and 3 years. Two in particular had become very close and dear friends. In all cases I was happy for them when they died.

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Re: Voluntary Euthanasia

Postby manas » Thu Oct 17, 2013 1:32 am

My main concern, is that old people who are very ill and close to dying, but not in pain nor wishing to end their lives before the natural term, might feel pressured into doing it, to ease the financial and other burdens on their families. That kind of pressure would be no doubt be legislated against, but in practice, I'll bet it will be exerted (or perceived) nonetheless, in some cases.
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Re: Voluntary Euthanasia

Postby kmath » Thu Oct 17, 2013 2:01 am

dagon wrote:
Most of the patients that I have worked with when they have got closer to death have said that they want to die. I have NEVER been told by any of my patients that “I don’t want to die”.

Ethically, as members of societies we need to accept that if we have a legislative frame work that denies the individual the right to end their own life then we have an ethical obligation to ensure that those suffering have the legal, financial and practical access to services that minimize the suffering. The services that can help in this regard extend far beyond that provided in medical models.

In the last 8 weeks I have said the finally goodbye to 6 friends who I had looked after on a daily basis for between 1 and 3 years. Two in particular had become very close and dear friends. In all cases I was happy for them when they died.

Metta
paul


Wow, thanks for sharing that. :anjali:
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Re: Voluntary Euthanasia

Postby robertk » Thu Oct 17, 2013 5:48 am

David N. Snyder wrote:Hi Robert,

I know, but see Bhikkhu Bodhi's comments in my post above. Bhikkhu Bodhi disagrees and suggests that he was an arahant before cutting.

Ok we must have a different definition of "noble level"
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Re: Voluntary Euthanasia

Postby robertk » Thu Oct 17, 2013 5:52 am

The pain experience d in the human realm is mild compared to that in lower realms
And few after death will be reborn as human according to the pali
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Re: Voluntary Euthanasia

Postby tiltbillings » Thu Oct 17, 2013 5:59 am

robertk wrote:The pain experience d in the human realm is mild compared to that in lower realms
And few after death will be reborn as human according to the pali
That is assuming that such realms really exist and that the hell realms business is not the typical scare the begeesus out people tactic to ensure good behavior.
This being is bound to samsara, kamma is his means for going beyond.
SN I, 38.

Ar scáth a chéile a mhaireas na daoine.
People live in one another’s shelter.

"We eat cold eels and think distant thoughts." -- Jack Johnson
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