Hinduism & Medical Ethics
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 definedby 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.
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 yogaÑseeking 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 asmahaprasthana, '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."
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.
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.
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.
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 inMerging 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 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 ofayurveda. 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.
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.
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.
While revering conception as a Divine act, Hindus have little hesitation to practice birth control, and there are remedies specified in ayurvedaboth 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."
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, whileayurveda has no tests for sterility, the likelihood of children is one of the major considerations when evaluating a couple's astrology prior to marriage.
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 andAtharva 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?"
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 becauseof 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 elsewhereÑparticularly 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.
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."
"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 doctorÑayurvedic or allopathicÑall 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."
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 theUpnaishads. 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."