Medical ethics in Buddhism

Lama Gonsar Rinpoche

Introduction

It is a great honor to have been given the opportunity to participate in this highly meaningful forum on Medicine and Ethics. 1 would like to express deep admiration and gratitude to my honored and dear friend Dr. Andreas Schapowal, through whose initiative and efforts such an event came into existence. 1 have been requested to speak on the religious systems of Hinduism and Buddhism. Since my knowledge of Hinduism is very limited, my contribution today is principally based on the modest knowledge 1 have of the Teaching of Buddha.

Buddhism and Hinduism are not only two great religions which originated in India, they are two ancient and profound living traditions of wisdom in the world and in particular Asia. They have many points in common concerning their view of the world, the beings and their situation. There are also many differences in subtle philosophical points as well as in the methods of spiritual training and practices. Although the name Hinduism is a late development, the philosophical systems and the spiritual traditions go back to very early, untraceable times. It has a very complex system of mythology, which is highly interesting. Most significant, however, are the spiritual teachings laid down by the great sages who appeared in different epochs, which have contributed much to the elevation and well-being of the people following them. One such contribution is the science of healing, which plays an important role in such transmissions. Highly qualified and precise explanations with regards to the nature and the cause of the human diseases are given as well as sophisticated methods of healing through natural medicines, surgery and physiotherapy. Also the relation between physical ailments and the psychological situation of a person is emphasized. In order to overcome the sufferings on the root level, various methods of meditation are elaborately taught. It was possible to preserve such a precious tradition up to our time through the activities of continuously appearing sages and masters in the holy land of India, which is a particularly fertile field for the growth of some of the most extraordinary spiritual traditions of the world. Hinduism is not a uniform philosophical system; rather, it is an aggregation of various systems of thought. It is also a rich and complex form of the cultural heritage of India.

Buddhism, or the Teaching of the Lord Buddha, was also born in India 2540 years ago, and through its extremely clear and logical presentation of the conventional and ultimate truth it very soon engulfed the hearts of countless people in India who became followers of the Buddha. Although Buddhism refutes some of the rigid structures of ancient Indian beliefs, such as the caste system or the theory of an absolute self and a creator, it shares many fundamental points with Hinduism, such as the law of karma, rebirth, infinity of the universe and the beings. It emphasizes strongly that the root or principal cause of suffering and happiness, which sentient beings are longing to obtain or to avoid, lies within the mind of sentient beings, while the external causes serve only as a condition. Therefore Buddha emphasizes the development of the right view, practice of the right action and training in the right mediation as an indispensable and just method to obtain freedom from the sufferings and a lasting state of peace and happiness. Nonetheless, the superficial symptoms of suffering such as physical ailments are by no means neglected but are also thoroughly dealt with.

Like in Hinduism, there is an extremely complex and sophisticated system of healing in Buddhism, too. One finds a lot of explanations about healing methods in various scriptures, such as in the Vinaya and in the Sutras, and especially in the four Medicine Tantras. In those teachings one finds very clear explanations on the cause, nature and signs of various ailments as well as methods of healing and methods of preparing medicines with plants, minerals and other substances. One also finds very precise explanations on medical ethics as well as the faults and qualities of a physician. Buddha pointed out very clearly that the root of all physical ailments and sufferings is to be traced in the mind of the individual; in other words, they are all productions of the three root poisons desire, hatred and ignorance. The ultimate cure from all sufferings is obtained by eliminating the root with the force of compassion and wisdom within one's mind. Such a method of healing as taught in the Buddhist Tantras is carried on by the great Masters of India and Tibet, and thanks to them it still continues to help countless beings up to the present time.

Human beings with their complex and delicate physical constitution are vulnerable and subject to all kinds of sufferings and ailments. As a result the science of medicine is one of the most outstanding fields of knowledge which has been desperately sought and cherished. Such knowledge is found and practiced in all human societies. Many eastern and western medical methods exist which are, much like religions, united in their goal yet very different in their way of pursuing it. Therefore just as it is a grave error to abuse other systems in favor of one's own, it is also an error to mix all systems. No matter which system one applies, what is common to everybody involved in the field of medicine is the correct motivation and the right action.

Nowadays, one of the most difficult questions raised in the world of medicine is the manipulation of the natural state of beings through the influence of technology. Of course this question is particularly linked with the allopathic system of medicine and does not apply to eastern methods. Still, it is a very important point which touches everybody living in this modern world. Advantages as well as disadvantages are voiced on both sides, and it is indeed not easy to make a clear judgement. lt requires deep and thorough investigation. There is always a fatal danger in generalizing these points lightly which are the most subtle and crucial to the life of sentient beings. There is an ever-growing need to combine the outer and inner methods of healing.

Ethics and medicine

According to Buddhism ethics and medicine are two inseparable unities. Ethics, or Shila in Sanskrit, means the right way of living as well as the right attitude of the mind. That is also the very essence of the Dharma or the Teaching. Shila is in itself the ultimate medicine for all the sufferings that exist. The Buddhist Master Shantideva has clearly pointed this out in the following prayer:

That which is the only medicine for the sufferings of the world
That which is the source of all happiness
May the Teaching flourish in the world for a long time
With respect and practice

Since the principal cause, the root of all sufferings including all the physical ailments, lie within one's own mind, the ultimate cure is achieved through bringing about an effective transformation within the individual. The process of such a transformation by means of eliminating negative actions of body, speech and mind and enhancing the positive conducts as well as the positive states of mind is the practice of ethics.

Buddha has often referred to medicine as the most suitable analogy for the Teaching. In the Four Noble Truths, his first Teaching, he clearly pointed out that one should

Know the sickness,
Abandon the cause of the sickness,
Aspire the cure and
Rely upon the medical treatment

In the same way one should

Know the suffering,
Abandon the cause,
Obtain the cessation
And follow the Path

This most fundamental Teaching of the Buddha is the common base of all aspects of Buddhism. Briefly speaking it emphasizes the need to recognize one's suffering state as well as its cause within one-self, then to aspire deeply the attainment of liberation and follow seriously the way or the right method.

The attitude one should have towards the Teacher and the Teaching is explained in medical terms as well. A seeker of Dharma should recognize himself as a patient, the Teaching as the perfect medicine, one's Spiritual Guide as a qualified physician and the intensive practice as the necessary therapy. It also shows clearly that the practice of the Teaching is nothing else than the process of applying the most effective therapy in order to achieve the complete cure from all sufferings. Likewise, the basic Buddhist practice of taking refuge in the Three Jewels Buddha, Dharma and Sangha - Buddha referring to the enlightened beings, Dharma to the Teaching and the realizations, and Sangha to the supreme community - is also explained in a medical sense. The analogy given is that of a patient relying upon the right treatment. It is said:

Take refuge in the Three Jewels,
See Buddha as the most qualified physician,
See the Dharma as a faultless medicine
And the Sangha as medical attendants

Just as in case of a disease, it is crucial for the patient's recovery not to rely just on anybody who may call himself a doctor or healer, but rather to entrust himself to somebody with the necessary qualities and qualifications, so on the spiritual level, too, one should not develop faith or take refuge in anything or anyone just because they are popular. Rather one must thoroughly investigate the person's abilities and qualities such as compassion, wisdom, etc. and only when one has gained a conviction that these qualities are present, then rely upon that person as one's refuge or Spiritual Guide.

Moreover, it is the medicine one takes which is absorbed by the body and then counteracts and overcomes the disease, not the doctor. Simply knowing about the medicine and being surrounded by it has no effect whatsoever. In much the same way, the actual refuge which helps us to overcome the causes of suffering within ourselves is the Dharma. However, Dharma is not only to be learned and understood, rather it is to be applied in practice by integrating it into one's attitude of mind as well as one's behavior.

Just as it is imperative for a patient's recovery to be constantly cared for not only by a qualified physician but also by a complete team including the cleaning personnel, one needs not only the guidance and protection of fully enlightened beings in order to attain enlightenment. One also needs the help, example and inspiration of the Sangha, that is, all those who find themselves on the path.

All this shows how closely religion and medicine are linked in Buddhism. The role of a Spiritual Guide and that of a physician are therefore very similar. The one who tries principally to help beings by showing the methods of developing one's mind through overcoming the negative states of the mind and developing the positive potentialities is regarded as a Spiritual Master, and the one who principally takes care of the beings by giving them medical treatment to overcome their physical ailments is refered to as a physician or medical doctor. The nature and the aim of these two activities are, however, identical, that is, to free beings from their sufferings. Therefore the conditions required for someone in such a position are also very similar. The indispensable common base for both is sincere compassion. The second indispensable factor is wisdom or well-mastered knowledge of the methods one applies. Without such compassion and wisdom one's efforts will not bear good and lasting benefits. lf the purpose of one's efforts is limited to one's own benefit such as wealth, position or fame, one actually exploits the suffering beings and one's work turns into mere business. Such an attitude, however, is not suitable in these fields of activity.

Thirdly, the responsible person should himself be someone in a harmonious state of body and mind. A person who is spiritually and physically in a degenerate state is not at all in a position to help others to make progress. Such an attempt would be like the blind leading the blind or a drunkard helping a drunkard.

In both cases the work is of a completely wholesome nature, directly benefiting sentient beings. According to Buddhism it comprises the so-called practice of the Paramitas or perfections. There are six Paramitas:

Dana-Paramita, the perfection of generosity
Shila-Paramita, the perfection of discipline or ethic
Shanti-Paramita, the perfection of patience
Virya-Paramita, the perfection of enthusiastic perseverance
Dhyana-Paramita, the perfection of concentration
Prajna-Paramita, the perfection of wisdom

Fulfilling the task of a Spiritual Guide or a perfect physician requires the practice of these six Paramitas. The work of such a person has to be a combination of these perfections. Although they can be explained on many different levels, at least their conventional level must be present in order to fulfill this task of helping others effectively. Then it will be a real service to all mankind and to the sentient beings, and that way it will also be beneficial to oneself. The help we give to others is the best help we can give to ourselves.

Thus the work of a Spiritual Guide and that of a physician are inseparable. In Tibet many great Masters are also among the most renowned physicians. In the scriptures it is said that a Bodhisattva, that is, someone who is determined to attain enlightenment for the sake of the sentient beings, should master five great sciences These are:

  • The science of art
  • The science of medicine
  • The science of language
  • The science of logic
  • The inner science of mental training

The last is the trunk of the tree and the others are like its branches with the same essence. The ideal way is to incorporate all in one, especially medicine and the inner science.

When we speak about wisdom in these fields, we should understand it in the context of a deep and far-sighted view, knowing that whatever is harmful in the long run, even though it may be temporarily helpful, should be seen as negative. On the other hand, something which may be temporarily painful but beneficial in the long run should be regarded as positive. With the advancement of technology many new methods and possibilities come up in the field of medicine as well. They have their advantages and disadvantages like every aspect of civilisation. However, the unchanging principle of the nature of this particular altruistic activity is compassion, which requires respect for life through recognizing that sentient beings, no matter in which form they exist, are not simply moving objects or machines, but possess the stream of precious consciousness which enables them to feel suffering and happiness as well as to cognize the objects of their mind. This particular characteristic of the beings gives them the well-deserved, special place within the entirety of existence.

In Buddhism, therefore, the central point of the Teaching is neither the Buddha nor any other divine being or philosophical entity but just the sentient beings. Everything is centered around them. Without relation to the experience of the sentient beings there are no other criteria on which the law of causality or action and result, as well as what is positive or negative or right or wrong, can be estab- lished.

So, in short, the principle of Buddhist ethics isAhimsa, which means"no harming." It means whatever is harmful to sentient beings is to be avoided and whatever benefits them truly is worthwhile to be pursued by all means, no matter in which field of knowledge.

I am concluding this presentation with my best wishes and the hope that such enriching encounters will be continued as they are a real starting point for enlightening efforts aiming at the future wellbeing of mankind.

References

Clifford T (1977) Tibetan Buddhist Medicine and Psychiatry - The Diamond Healing. Samuel Weiser Inc., York Beach, Maine
Geshe Rabten (1978) Mind and its functions. Edition Rabten, Le Mont-Pèlerin
Geshe Rabten (1997) Schatz des Dharma. Edition Rabten, Le Mont-Pèlerin
Parfionovitch Y, Meyer F, Dorje Gyurme (1992) Tibetan Medical Paintings, Vol. 1- 2. Harry N. Abrams Inc., New York
Yeshi Donden (1986) Health Trough Balance - An Introduction to Tibetan Medicine. Snow Lion Publication, Ithaca, New York

Lama Gonsar Rinpoche
Centre des Hautes Études Tibétaines
CH- 1801 Le Mont-Pèlerin