Talk on Buddhist Ethics to Kaiser Ethics Committee
Feb 12, 2010
First, I am very honored and happy to be here. I hope I can contribute something of value, though I am not at all sure that I can. I want to thank you - and Kathleen - for inviting me. I accepted imagining that I would come and mostly listen to you and learn from you and comment from my own perspective when I had something to say. I didn't realize I was going to be expected to address you at some length before that conversation. This is not so easy for me because I am not at all sure of what your concerns are nor do I know what or how you think about ethics and ethical philosophy. I imagine that you are making crucial life and death ethical decisions on a daily basis, as you deal with real people and their medical problems, so I wonder what a person like me, who doesn't have such awesome responsibilities, could possibly say to you that would be of benefit. Maybe it will help me to begin if I acknowledge all that at the outset.
My topic for today is Buddhist ethics, and I speak to this topic not as an expert or as a spokesperson for Buddhism, but simply as one person who has practiced Buddhism for a long time. So please don't imagine that what I will say is what all Buddhists would say, or what the tradition officially would say. In fact, as I am sure you are aware, there is no Buddhist position on this or that, just as there is really no Christian or Jewish or Muslim position, and no one medical position - there are many positions. People always disagree. Some opinions may be more sensible or better informed than others.
As you probably know, Buddhism is not a revealed religion, which is to say it is a non-theistic religion. One definition of religion is "belief in a supreme being." By this definition Buddhism is not a religion, and, in fact, in 1893, at the first World Parliament of Religions, there was debate as to whether or not to include the Buddhists, because Buddhism by this definition doesn't qualify as a religion. Perhaps Buddhism is a philosophy. In fact Buddhists were invited to the Parliament despite this, and now though I think we would all recognize Buddhism as a religion (it has beliefs, clergy, ritual, scripture, and so on) Buddhism's radical difference as a non-theistic religion remains. The question is, what difference does this make for ethics?
In theistic religions morality is revealed and ordained by the deity. God gives the Ten Commandments at Sinai, and this sets the tone for all Jewish and Christian morality. I apologize for not being even basically knowledgeable about Islam, but I do know that as a theistic religion it too finds the basis for morality in God's word and intention. In revealed religion we know, we absolutely know, what is right and what is wrong. What is right is what God tells us is right, what is wrong is what God tells us is wrong. God is by definition good, so no further justification is needed. There are no two ways about morality. For people who believe that God's word is written in plain English in the bible, and is therefore perfectly clear, morality is also perfectly clear, and there is a lot of passion in defending what is right and opposing what is wrong. I am sure you are all familiar with this attitude and have encountered it from time to time in your work, even here in the Bay Area, where such an understanding of the bible and of morality is much more rare than it is in other parts of the country and the world. For others who understand that the words of the bible are not necessarily so clear, and are subject to interpretation, and perhaps even to very broad interpretation and reinterpretation over time as society changes, there are many fuzzy issues and fuzzy areas, but still, the sense is that there is a true right and definite wrong, and that it is our difficult job to discover what they are and not confuse them. In our modern world there are many who don't know whether they believe in God, and many who don't care much one way or the other about God and may be quite vague on the concept. There are others who absolutely (and I use this word on purpose) do not believe in God and think that people who do believe are foolish, even dangerous. But even for these people questions of morality are tinged with a sense of righteousness and passion that goes with our Judeo-Christian social and cultural conditioning. I point this out because we take this passion so much for granted that we may not notice it. We are all, regardless of our theological commitments or lack of them, pretty moralistic. We are all pretty passionate about our beliefs about right and wrong.
The way ethical questions are held in Buddhist cultures and other non-theistic cultures is quite different from this. Though there is a strong concern for what is ethical, it is held and understood in a completely different way.
Buddhism seems not to be concerned with the basic questions that theological religions engage, questions whose answer is God. Questions like the origin and ultimate meaning of the world and time. The Buddha famously refused to consider such questions when asked, because, as he put it, such questions do not conduce to liberation and happiness. He gave the famous analogy (which, not incidentally, is a medical analogy) of a man shot with an arrow, who is lying on the ground dying. A person comes along who is ready to withdraw the arrow from the man's breast and save his life but the man stops him and says, "Before you pull the arrow out, I want to know some things about it. Who made this arrow? What sort of wood is the shaft made of, what feathers are at the end of the arrow, what is the tip made of, where was the arrow fashioned? What sort of man shot this arrow at me? Was he a tall man, a short man, a red man, a white man," and so on, several pages of such questions. Before the man would have a chance to learn the answers to all his possibly unending questions, the Buddha said, he would be dead. Better then to set these questions aside and pull the arrow out and save the man's life. So the first point and purpose of Buddhism is not to ascertain who is the author of the world so as to pay homage to him or her or it and take direction from him or her or it, but rather to cure the human illness - spiritual illness, of which physical illness is but a symptom.
I think this is very interesting to think about from a medical perspective. Human beings are fundamentally ill. Human beings without exception have an incurable terminal disease. All doctors lose one hundred per cent of their patients. All physical and mental illness is simply a symptom of the fundamental disease, which is the radical vulnerability - which leads to the eventual demise - of the human body and mind. All doctors should write on all death certificates: cause of death: life. Cancer, heart disease, AIDS, and so on are proximate, adventitious, causes. The actual and fundamental cause of death is life. Once there is life, death will follow. All creatures die but only human beings understand that they will die. All languages have a word for death, although no one knows exactly what this word means, no one knows what the experience of death, the state of being dead, is; that is, if death is an experience or a state. And if death is not an experience or a state, if it is nothing at all - all the more reason to be utterly confused about it. And yet death remains the fundamental fact of life. This reality - that death is unknowable, uncontrollable, and yet conditions us completely - makes us all nervous, I think, however unaware of this we may be. And this nervousness, this dread, this fundamental anxiety, is the human illness that the Buddha wants to cure. It is the reason why we worry about our conduct. It seems somehow clear to us, though in a very unclear way, that since we don't know what death is or if it is or what happens to us after death that we had better be careful about how we live, about what we do. Otherwise we will go to hell or be reborn into bad realms or endure meaningless tortured lives in the present. Other creatures have no concept of mortality and no concept of ethics. The two go together.
In a word, the spiritual path is the cure proposed by the Buddha for the human illness of existential dread. The Path, as he conceived it, involves three main elements, morality, meditation, and insight. The three are likened to the three legs of a tripod, perfectly in balance. With morality the mind is made clear and peaceful and suffused with love. This makes deep contemplation possible. And deep contemplation leads to the insight that our identity is not limited to the body and mind as we conventionally know it - that we are in fact in identity with everything, and once we realize this the dread and tragedy of sickness old age and death is removed from us, and we can, with a confident heart, age, be sick, and die, knowing that this is a natural and a joyful process that will not diminish what we most truly are.
A footnote here to say that the Western philosopher whose thought is perhaps closest to that of the Buddha is Spinoza, who may be the originator in the West of what we now call "secularism." Spinoza was a thoroughgoing rationalist - but he was not an atheist. For him the existence of God was an obviously self-evident logical proposition. Spinoza believed that through rational contemplation of the world and of the human mind and emotions we could arrive at an expansion of identity so thorough that we would lose our fear of death and embrace all of life and humanity as ourselves and would no longer need what he called "superstitious religion." We could be ethical, understanding and kind to our fellow humans, without being ordered to be that way by a punishing God. For Spinoza God was the world's true and infinite beauty, which would always be beyond what any finite human mind could grasp, and yet the human mind could through rational contemplation appreciate this and extend knowledge. Einstein was a Spinozist as were and are many scientists still -whether they realize it or not.
All of what I have said speaks to a Buddhist philosophy of ethics, the why of ethics. It speaks to the attitude that underlies all Buddhist considerations of ethics. Now to the how of ethics, the on-the-ground practice of ethical conduct.
Not surprisingly, Buddhist ethics doesn't differ much from general Western ethics. The golden rule applies: treat others as you would treat yourself, which implies that one would treat one's self fairly and well. As one part of the three part program for liberation from suffering, ethics is a practical matter. Ethics is effective, for one's self as well as for others. To keep the mind and heart clear for contemplation and insight there should be no wild or erratic behavior even privately, no stirring up the mind and heart. And to ensure that there is no outward disturbance or trouble treat others with loving kindness so as to maximize the chance for harmonious relations. In the end, liberation is exactly the transforming insight that the narrow sense of personal identity is conditional and false. Therefore others are one's self, one's self is others, so there is a full measure of love for self as others and others as self, and a strong motivation to act out of love, to share life with others, to aid them in their need, to cultivate a great and ultimate selflessness, which would be the sign and mark of liberation.
Since ethics is part of a program for liberation rather than a set of rules ordained by an all-powerful God, ethics in Buddhism goes along with a general sense of cultivating the heart. Ethics is a kind of training - training in opening the heart, in kindness, in self-expansion. It is a practice rather than a rule. To be sure, the practice of ethics may involve following rules, but these rules are considered training rules rather than absolutes. This doesn't mean that Buddhist ethics is situational ethics or relativistic ethics; yet neither is Buddhist ethics absolute. The Western conceptual framework of absolute and relative simply doesn't fit the Buddhist understanding. In Buddhist ethics there is right conduct and wrong conduct, it is not a matter of opinion or mere social mores: in this sense Buddhist ethics is absolute. But the meaning of and appearance of right and wrong conduct may be conditioned by intention and situation: in that sense Buddhist ethics is not absolute.
This means that Buddhist ethics is as much a matter of inward cultivation, the condition of the heart, as it is a matter of outward conduct. It's as much a matter of spirit and attitude as it is a matter of letter of the law. This may seem to some to be a slippery slope. But it would not be a slippery slope within the context of a Buddhist culture in which there are communities, teachers, clergy, ritual, and scripture, all for the purpose of aiding and directing spiritual cultivation.
In the Soto Zen Buddhism that I practice - to give you one quick specific example -we follow 16 precepts. These include both broad principles - like taking refuge in the awakened heart as our primary guide and motivation - as well as more specific guidelines, like not committing sexual misconduct, not intoxicating the mind, not lying, and not speaking ill of others. The typical Zen student who practices with me and wants to explicitly practice the discipline of ethical conduct will study fairly diligently for about three years, which means practicing meditation regularly both at home and in community, paying attention to conduct in daily life, speaking with me and other students about precepts, and then committing to living by the precepts in a solemn public ritual. The sense of this commitment is not that the precepts are rules for living that must be followed to the letter, but rather that they are tools for reflection, lenses through which to view one's life, ways to come to a deeper understanding of and deeper connection to others. It is almost never the case that people in the community point fingers at one another, accusing their fellow practitioners of "breaking a precept." Such a concept is unknown. We are all trying to practice the precepts, with the understanding that there is really no way to do so perfectly, and that, from another perspective, there is no way not to do it perfectly, since whatever happens - including our transgressions intentional or unintentional - is going to be part of our development. Even if we make mistakes that we recognize to be mistakes, we can repent and change our ways, and learn something in the process. In this way there can be a maximum of effort for the good, a maximum of forgiveness, and a minimum of guilt and recrimination.
Is it interesting that much of contemporary Western thought about ethics is beginning to converge with basic Buddhist ethical concepts and understandings. It is a little difficult for me to summarize in brief what I want to say about this, but let me take a stab at it:
It is becoming clear that ethics is not so much a matter of what we think is right or wrong, or what we should think is right or wrong, as it is a matter of how we feel. Ethics, we now begin to understand, is a category of emotional intelligence - a concept that itself was unknown a few decades ago, but is now very important throughout our society. The rapidly advancing field of cognitive science makes it clear that there is no thinking without feeling, our brains simply work that way. Our moral reasoning is not, as we had thought, the motive force of our ethical conduct; reasoning comes later, after we have already felt our way into what we know to be right or wrong. In a recent New York Times column on the new Western sense of morality, David Brooks (April 7,2009) quotes Jonathan Haidt of the University of Virginia, "The emotions are in fact in charge of the temple of morality, and... moral reasoning is really just a servant masquerading as a high priest."
And in evolutionary studies, it is now commonplace to recognize that morality may not be a matter of rules ordained on high, absolute imperatives, but rather built-in evolutionary tendencies to altruism, cooperation, and concern for others that cause us naturally to gravitate toward moral codes that connect us to others in fairness, mutual concern, and deep human bonding. If these things are true, and all our best evidence seems to suggest that they are, then morality and ethical conduct are, as the Buddha intuited centuries ago, deeply embedded human feelings that aid us in finding the spiritual dimension of our living and that will bring us some happiness and healthy adjustment to the world and to each other. Brooks writes, "The rise and now dominance of this emotional approach to morality is an epochal change. It challenges all sorts of traditions. It challenges the bookish way philosophy is conceived by most people. It challenges the Talmudic tradition, with its hyper-rational scrutiny of texts. (and, I would add, it challenges the Christian and Muslim versions of this text-based rationality as well). It challenges the new atheists who see themselves involved in a war of reason against faith and who have an unwarranted faith in the power of pure reason and in the purity of their own reason."
Let me end with my own sense of what all this might mean for medical ethics; that is, for actual situations medical professionals may find themselves in on a daily basis. My guess is that what I will say will echo what you have already come to during the course of your work.
First, if ethics is a matter of deep feeling as well as thinking, and if feeling can be cultivated, that is, if our capacity for empathy and compassion is not fixed but is flexible - as Buddhism long ago claimed, and as contemporary brain studies show - then it behooves people who work with life and death ethical issues to be involved in an active and ongoing cultivation of their capacity for human feeling. I know you are all very busy. How would you find the time for this? But it may not take any extra time. It may be a matter of quality of presence, not quantity of training. And it may be the great opportunity of a lifetime, not merely another professional training you now need to obtain.
And second, ethics is a social virtue, it is something we practice largely together. It involves feeling the feelings of others, and changing and being changed by the feelings of others. If ethics is not reducible to hard and fast rules, and is always a discernment, it is a discernment we make together, in teams of experienced professionals who practice mutual respect, teams that involve patients and their families, and the needs and desires of our society at large. Remembering and acting in this spirit this may reframe our ethical dilemmas and problems as opportunities for discovery and connection.
I realize that sensitive ethical determinations are not made in private or without references to hospital policies and national, state, and local laws, the media, and public opinion. There are plenty of strict constraints, plenty of specific rules, plenty of potential difficult consequences for missteps. Still, in the end, as I assume many of you would attest, the relationship between the physician and his or her team, and that team's relationship to the patient and his or her family, is a powerful factor in decision-making, and one that should be fully and passionately engaged, whatever the constraints. Apart from the policies and laws, apart from what our belief systems tell us is the right and wrong of the case, what do we really feel? And what do we feel together, as a community of concerned people? Can we be honest and courageous enough to entertain that, and to challenge ourselves to examine and extend our feeling for the greatest good of the greatest number?