On 17 June 2016, the Parliament of Canada passed a bill legalizing assisted dying. Canada joins a small group of nations, including Switzerland, Japan, the Netherlands, Colombia and Albania, that has legalized assisted suicide.

Introduction

Suicide and euthanasia pose very challenging and highly emotionally-charged ethical, legal and political questions. Is it moral to permit, assist in, or engage in the mercy killing of a patient suffering from an incurable, painful terminal illness? Should suicide and euthanasia ever be legal? It may be that no answer can ever be provided that will be fully satisfactory to everyone.

What can Buddhist philosophy say about suicide and end-of-life decisions? Buddhist teachings are rooted in ideas about suffering (dukkha) and attachment (upādāna). Maybe these teachings can offer a certain perspective through which one can view the debate on suicide and euthanasia.

Thinking about end-of-life decisions is a reflection on how one lives one's life and how one faces the inevitability of death. These are questions central not only to Buddhism, but to all major philosophical traditions from Greco-Roman philosophical schools in the West to those of the Far East. These are issues that confront every single person—deeply intimate questions that each individual will have the opportunity to face and examine in the course of one's life.

Definitions & Scope

Important key terms to consider in any discussion of suicide and end-of-life decisions are physician-assisted suicidevoluntary euthanasiainvoluntary euthanasia, and non-voluntary euthanasia.

  • Physician-assisted suicide (PAS): Suicide by a terminally ill patient done with the assistance of a physician, usually through a physician’s prescription of drugs that will lead to the hastening of the patient's death.
  • Voluntary euthanasia: The killing of a terminally ill patient on the request of the patient.
  • Involuntary euthanasia: The killing of a terminally ill patient, who is still capable of consenting to the act but does not.
  • Non-voluntary euthanasia: The killing of a terminally ill patient who is not capable of consenting due to the patient being in comatose or other states that render the patient incapable of expressing an opinion on the act.

Specifically for this post, the most important clarification is in understanding the two forms of mercy killing: active and passive.

  • Active euthanasia: The killing of a patient, through means such as lethal injections.
  • Passive euthanasia: The withdrawing or withholding of treatment for a patient that will lead to the patient’s death.

Clear definitions are helpful in understanding how key Buddhist philosophical teachings, such as suffering, apply to living as well as to dying.

Canadian & American Debates

Until 2016, PAS and euthanasia were illegal in Canada. Under the criminal code of Canada, physicians who engaged in either PAS or euthanasia were guilty of "culpable homicide." Canadian public opinion, however, in recent decades has tended toward greater respect for autonomy, or individual freedom (including the freedom of choosing to die), which is seen as foundational to Canadian liberal democracy. Individual freedom has been cited as a justification of PAS and voluntary euthanasia.

In February 2015, prohibition against active euthanasia was overturned in Canada by the Canadian Supreme Court. The court ruled that adult Canadians facing terminal illness were entitled to PAS. In June 2016, the Canadian Parliament passed a bill legalizing and regulating assisted dying.

The road to legalizing assisted dying in Canada was a long one. Parliament resisted passing legislation legalizing either PAS or euthanasia due to concerns over the “protection of the vulnerable.” The concern here is that those who are terminally ill may, in some cases, be surrendering their right to decide on life or death to others, something many find unacceptable. For PAS and euthanasia to be legalized, appropriate mechanisms and regulations must be put in place to ensure a patient-centred approach to end-of-life decision-making.

Despite the law’s clear position on the illegality of PAS and euthanasia in Canada until very recently, there was, as described by a 2013 study on the subject published in the International Journal of Law and Psychiatry, a “clear trend toward leniency in the sentencing and a similar trend toward prosecutorial discretion….” PAS and euthanasia were being conducted in Canada in secrecy and even when such cases came into light, there was a reluctance to prosecute. This clearly reflected the shift in public opinion toward greater acceptance of PAS and euthanasia in Canada—ultimately leading to the legalization of PAS and euthanasia in the country in 2016.

In the United States, where no more than five states have legalized PAS, arguments against such practices have traditionally been based on long-established Christian values—that life is a divine gift and, thus, humans do not have the authority to take it away. Traditional values, however, are giving way to postmodernist emphases on material wellbeing, self-expression, and higher quality of life. The argument to legalize PAS and euthanasia, thus, include the argument to alleviate the suffering of the terminally ill who are enduring great distress as a result of their medical conditions.

To summarize the Canadian and American debates, euthanasia is defended as a last resort relief of terrible suffering. It is also defended on the grounds of preserving autonomy and individual self-determinism.

On the other side of the aisle, the argument against euthanasia centres on traditional values surrounding the sanctity of life.

Other arguments against euthanasia include that it undermines the development of proper palliative care, that it is a slippery-slope toward “normalization” of the practice, and that it goes against the ethical foundations of the medical practice itself, which may be seen as essentially a practice that saves lives and not one that ends lives.

Buddhist Teachings

Note: the following interpretation of Buddhist ideas has deliberately avoided the topic of death and rebirth (reincarnation/samsara), a widespread assumption in many southern and eastern Asian philosophical systems, or any conjecturing on the afterlife due to the topic's speculative nature.

Buddhism may be well-placed to offer opinions on end-of-life decision-making because of its careful study of the problem of suffering. Indeed, the entire Buddhist project in a nutshell, may be described as the endeavour to overcome suffering in life. Since a terminally ill patient's distress is the main justification for permitting PAS and euthanasia, Buddhist teachings on suffering may be relevant in this conversation.

The first of the Buddha's Four Noble Truths lays out that life is full of suffering. The term suffering is translated from the Pāli word dukkha and can also be rendered in English as dissatisfaction. The second Noble Truth instructs that the cause of suffering is desire or craving. This craving leads to unhealthy attachments. A state of healthy non-attachment is, thus, encouraged to be cultivate among Buddhists. This non-attachment to all things, including to life and even to death, Buddhists believe, help to alleviate mental or emotional suffering and distress.

Buddhists see all things as being in a state of flux. All things are constantly changing. This includes one's life. To become unhealthily attached to one's life can lead an exaggerated fear of death and cause suffering. Buddhist teachings encourage one to come to terms with the finite, ever-changing nature of things so as to be free of emotional suffering. Here, then, one might see Buddhism as appearing to offer a supportive response to passive forms of suicide and euthanasia.

While Buddhism advises guarding against an unhealthy attachment to life, it also discourages becoming fixated on death (even as a way to relief physical suffering). Buddhism places emphasis on the alleviation of mental suffering over physical suffering. Physical suffering is seen as inevitable but how one responds mentally and emotionally is within one's control.

In the simile The Dart of Painful Feelings, the Buddha explains that when one is struck with a dart, he or she is virtually being struck twice since the pain is felt twice—once physically and once mentally. Through practice, an individual should be able to limit the effects of physical suffering on mental suffering. This insight on the relationship between an individual and his or her physical suffering may have much to offer for individuals suffering from physical pain due to medical conditions. It may also be interpreted as discouraging active forms of suicide and euthanasia.

Instead of finding relief in death Buddhism appears to encourage finding relief through mental discipline.

So...

While Buddhism doesn't appear to have a single, universal response that either permits or prohibits all cases of suicide or euthanasia, it does seem to have guiding principles on how one approaches life and death.

These principles appear to place emphasis on the elimination of mental suffering over physical suffering. The result seems to encourage the attitude of letting one's life run its natural course, despite whatever physical suffering one may face (which is seen as an inevitable part of life). That means to neither actively end one's life prematurely nor try to unnecessarily prolong life through active treatment. So while active euthanasia is not encouraged, passive euthanasia may be acceptable in Buddhism.

That said, many Buddhist communities have historically permitted active euthanasia. The history of these precedents is not touched upon in this post. If the topic interests you, please check out Peter Harvey's An Introduction to Buddhist Ethics. The book includes a section devoted to the discussion of suicide and euthanasia from a Buddhist ethical point-of-view and touches on historical practices by Buddhists.

Further Reading

This post is not intended to be any sort of final word in the end-of-life debate. The intention is to try to bring a non-mainstream perspective into the conversation.

Only a very simplified version of Buddhist philosophy is presented here. If the topic interests you and you'd like to learn more, the following materials were consulted in the writing of this post. It might be a good place to start for anyone interested in reading more and discovering their own unique perspective on this topic.

The interpretations in this post are in no way endorsed by the sources and authors listed below.

  • Bhikkhu Bodhi. (2005). In the Buddha's Words: An Anthology of Discourses from the Pāli Canon. Boston: Wisdom Publications.
  • Canada's Parliament Passes Assisted Suicide Bill. (2016, June 18). BBC News. Retrieved from http://www.bbc.com/news/world-us-canada-36566214.
  • Harvey, Peter. (2000). An Introduction to Buddhist Ethics: Foundations, Values and Issues. Cambridge: Cambridge University Press.
  • Keown, D. (1996). Buddhism: A Very Short Introduction. Oxford: Oxford University Press.
  • Keown, D. (2005). Buddhist Ethics: A Very Short Introduction. Oxford: Oxford University Press.
  • Perrett, R. W. (1996). Buddhism, Euthanasia and the Sanctity of Life. Journal of Medical Ethics, 309-313.
  • Schafer, A. (2013). Physician Assisted Suicide: The Great Canadian Euthanasia Debate. International Journal of Law and Psychiatry, 522-531.
  • Van der Heide, A. (2013). Assisted suicide and euthanasia. In M. J. Aminoff, F. Boller, & D. F. Swaab, Handbook of Clinical Neurology (Vol. 118, pp. 181-189). Amsterdam: Elsevier.