On 4 December 2014, the group gathered to discuss life and death in Buddhism, particularly with regard to end of life care.
Keown, Damien (2005) “End of Life: the Buddhist view.” Lancet 366:952-955.
Keown, Damien (2010) “Buddhism, Brain Death, and Organ Transplantation.” J. Buddhist Ethics 17.
Notes on Keown 2005
Buddhism requires no formalities or rituals for death and does not place limitations on medical care or treatment. It does encourage “mindfulness and mental clarity” throughout life and particularly at the time of death in order to have a better transition to rebirth (reincarnation).
Buddhism has no central authority to rule on doctrine or ethics, but “compassion and respect for life” are fundamental.
Each incarnation stretches from conception to death, during which time the individual should be treated with dignity. [Buddhists consider abortion a moral evil. In recent decades, some have recognized it as part of a complex of moral issues. Particularly, if the mother’s health is at risk, these other issues must be taken into account.]
Death reflects three absences in a body: vitality (ayu, possibly metabolism), heat (usma, heat), and sentiency (viññana). Some Buddhists maintain that the Buddha and others entered a deep trance in which these signs were absent, complicating the issue.
The brain death criterion has been challenged in Japan, where many fear the premature declaration of death to procure organs for transplant.
Buddhists are in accord with modern science that patients capable of persisting without machine support are alive, even if not conscious. “damage to a physical organ (the brain) prevents sentiency (viññana) from functioning in one of its primary modes, namely mental awareness (mano-viññana)”, but is still alive.
The opportunity for caregivers to act compassionately is important as well.
Buddhism has a strong prohibition against taking life, even in cases where it would seem to diminish suffering. One precedent (Samantapasadika, v 2, p 467) argues that in protracted illness, if cure is not possible and the caregivers are worn out, a patient may refuse food and treatment. Keown argues that the difference has to do with not seeking death and with not being attached to life.
Notes on Keown 2010
Rejects the concept of brain death as death for Buddhists.
Citing Karma Lekshe Tsomo, provides three arguments for organ donation: 1) to sever attachment to your body 2) to compassionately value another’s health 3) to gain merit in future lives.
On the other hand, there is a Tibetan tradition of not disposing of a body until 3 days after the heart stops beating, for consciousness may still reside within. We know from science that the body can still respond systemically to stress after brain death.
The author cites numerous stories of profound generosity (dāna) in Buddhist literature, including bodily harm to self to feed others, but argues they should be viewed as fables, rather than examples. Generosity should be balanced by prudence.
In Buddhism the “subtle consciousness” persists through death, but may remain after brain death. How might this be viewed by science? There is a concept of cessation (nirodha), a deep state of meditation in which all feeling and perception are suspended and normal biological functions are on hold – in other words, suspended animation.
The author suggests “death of the body as a whole” as the proper definition for death – in other words a physiological definition, wherein joint function ends and the body dis-integrates. Buddhism refuses to equate cognition with life.
“When all is said and done we do not live two lives—a brain life and a body life—and die two deaths—a brain death and a body death. One and the same life manifests itself in our brain and body, and throughout the psycho-physical unity which is a human being.” 19
From this perspective organ donation is not practical without an unacceptable willingness to seek death for the donor.
Death and suffering appear to be unavoidable in Buddhism. Whereas Western monotheisms see death and pain as the result of separation from God (a.k.a. evil), Buddhism views death and pain as a natural part of experience. It is only suffering through our aversion to death and pain that is to be avoided. Death, being both extreme and scary, gives us great opportunity for the practice of mindfulness and clarity. One can be more aware of the distinction between (but not separation of) mental experience and physical existence.
We noted that while Buddhism, per se, has no death rituals, it has almost always been found in cultures that do. Thus Buddhists are also usually associated with communities that have Confucian, Taoist, or Hindu death rituals.
We noted that Keown seems to equate medical practice with science.
We were all intrigued by the idea that compassion for exhausted caregivers might be a reason for a dying person – without hope of recovery – to forgo further treatment, but were divided on the implications. Some felt that this could be abstracted to a more general case of compassionate allocation of resources, as in the case of truly expensive surgery. Others objected that it was “seeking death” unless all options had been fully exhausted.
We were unsatisfied with the treatment of nama and rupa in the article, translated as immaterial and material aspects of the person. We saw them more as name and form (traditional translation) noting the similarity with names in the Islamic conception of person. Nama is that which distinguishes experiences. Rupa corresponds with the body.
We found it interesting that Keown seems to settle on a physiological definition of death (loss of heat ~ loss of metabolism ~ loss of homeostasis).
The Buddha repeatedly emphasized that nothing persists, so the question of what persists through death is unasked in Buddhism. The Hindu notion of karma, as a balance sheet for a particular individual, surviving into rebirth, has been rejected. Instead, there is a more dynamic notion that our actions have consequences for ourselves and others. Too much attention to the “ontological” question distracts from attention to compassion, mindfulness, and clarity.