Transcending a Bioethics of Buddhist Compassion
by Susumu Shimazono
Human organs are being bought and sold for transplant operations all over the world, and this trend is not necessarily declining. In Japan, buying and selling organs is not supposed to be happening, but how long will that last? Transplants of organs between living family members are becoming relatively more common in Japan; transplants not only of kidneys but also of liver tissue are also increasing. However, why should this be all right between family members but not all right between people with a more distant relationship? In 2006, the media reported that a doctor in Ehime Prefecture repeatedly transplanted diseased kidneys removed from patients into more seriously ill recipients. As the lack of healthy and postmortem donors meant accepting a diseased kidney was the only alternative to death, the recipients and their families were deeply grateful to the doctor.
Some people also offer their sperm and eggs for use in medical treatments, a boon to couples in which the wife has been unable to become pregnant. Imagine the joy of couples finally able to have a child! Shouldn't we sanction sperm and egg donation as long as it is not financially compensated? Perhaps we should even approve of surrogate mothers who offer to give birth to other people's babies. This practice is not allowed in Japan, but it is in South Korea. It is also said that over 2,000 eggs have been offered for use in human embryo cloning research in that country. Eggs are being donated for in vitro insemination, but can we say that they should not be used for research aimed at saving patients with diseases resistant to existing cures? Drug-induced ovulation is a serious matter for both the body and mind of the donor--in some cases it can even lead to death. However, isn't the procedure safe for women who react with insignificant side effects?
How should we answer these and the many other questions posed by the progress of new medical technologies from the standpoint of Buddhist ethics? The first thing that comes to mind is the concept of jihi, Buddhist compassion. The Japanese word is composed of two kanji characters, ji, meaning "benevolence," and hi, meaning "compassion." Buddhist compassion consists in giving comfort to others and relieving their suffering. Looking at the Jataka tales, which describe the previous lives of the Buddha, we find stories of how he voluntarily sacrifices his own life to try to save the lives of others. The story of the prince who offered his own body as a meal to starving tigers is one of the more well-known tales. From the point of view of those who escape death by receiving donated organs or obtain a child by receiving donated gametes or making use of the services of a surrogate mother, these medical technologies are an occasion for rejoicing. Doesn't this mean that buying and selling organs and surrogate motherhood are allowable and in line with the teaching of Buddhist compassion?
Looking at actual, individual cases, we might be led to believe that this is indeed an appropriate argument. However, the matter is not quite so simple. To actually "voluntarily sacrifice one's body," as the Buddha does in the Jataka tales--this is not something just anyone can do without extreme difficulty. It is only really possible for those who are so exceedingly pure and good that, like the Buddha, they fall into a category of unique beings. There are very few people who, on honest reflection, would say that they are capable of doing such a thing. Thus, if we advocate such sacrifices as manifestations of Buddhist compassion, we are in fact asking of others something we cannot do ourselves. We tend to think of Buddhist compassion as an unlimited good, but in reality, serious harm or loss may come to the person trying to put it into practice. Are we really taking this not inconsiderable possibility into account when we advocate acts of Buddhist compassion by others?
One reason we tend to use of the concept of Buddhist compassion somewhat lightly may be because the word jihi was originally used largely in the context of an asymmetrical relationship. This kind of compassion is primarily taken to be an attribute of the Buddha, with human beings understood as recipients of the Buddha's compassion. There are limitations to the conscious practice of Buddhist compassion by human beings. People who think of themselves as voluntarily practicing Buddhist compassion are relatively few, and so self-awareness of these limitations is also bound to be rare. In considering problems of bioethics, we need to re-evaluate what we mean when we speak of Buddhist compassion in the context of interpersonal action. When a person attempts to put it into practice, there is a significant possibility that that person will suffer loss or damage of some kind. Thus, what additional factors do we need to consider when we ask for something that requires an act of Buddhist compassion by another?
One factor is how to apply the Buddhist precept against killing. In the field of bioethics studies in the United States, four principles are normally given as criteria for defining bioethical acts: autonomy, non-maleficence, beneficence, and justice. Beneficence and non-maleficence appear to overlap, but beneficence addresses the potential for goodness and happiness, while non-maleficence evokes averting the threat of the possibilities for evil and violence. Where Buddhist compassion relates more deeply to the principle of beneficence, the Buddhist precept against killing relates to the principle of non-maleficence. This precept says we should not kill or harm any living thing, but in a more modern interpretation we can take it to mean that, in any event, we should refrain from violence against other people.
We need to think about whether or not we should sanction the buying and selling of organs, human egg donation, and surrogate motherhood in the light of this modern interpretation of the Buddhist precept against killing. In most cases, people offering their organs for sale are poor people who need money for daily life in the present, even if this means shortening their future life span. Little research has been done on whether donors selling organs are more likely to fall ill afterward or how much the procedure might be shortening their lives. However, it would probably be overly optimistic to assume that donating a kidney shortens the donor's life span in only a small minority of cases, and the same most likely goes for egg donation and surrogate motherhood.
We also need to make educated guesses about what might happen if these procedures come to be perceived as a good thing as they spread around the world, and become part of normal behavior in human society. If donating human eggs were socially sanctioned, even though regulations might allow only voluntary donation, in fact many women would probably find themselves in a position where they have no choice but to donate their eggs. The same can be said for selling organs and surrogate motherhood. Research already shows that, even in the case of parts of organs being donated by the patient's living family members, many people find themselves forced into a position where they have no choice but to become a donor. If this is a true reflection of reality, it comes close to coercing people in a position of weakness to sacrifice their own health in the service of others. This violates the principle of non-maleficence, and goes against the modern interpretation of the Buddhist precept against killing.
Another factor we need to take into account in addition to Buddhist compassion is the concept of bodhisattva practice as taught in Mahayana Buddhism. Bodhisattva practice is altruistic action, and might be defined as Buddhist compassion put into practice, but a stronger sense of mutual equality between giver and receiver is implied in the case of bodhisattva practice. The Lotus Sutra is well known as the sutra in which bodhisattva practice is most forcefully expressed; in its twentieth chapter, "Bodhisattva Never Despise," there appears a bodhisattva who worships the buddha-nature in every person he encounters. This behavior causes some people to become suspicious and in some cases to treat him with malice or violence, but this does nothing to deter Bodhisattva Never Despise from worshipping them. The concept of bodhisattva practice is understood as a relationship of mutuality in which one person can put himself in the place of another and vice versa. It encourages people to have a feeling for the weightiness of another's existence, and to be open and welcoming toward others even in the full realization that mutually interacting with others will inevitably involve each hurting the other somewhere along the line.
What I would like to emphasize is that the concept of bodhisattva practice includes the notion of equality and mutuality between those who interact with one another. Referring to the concept of bodhisattva practice should provide us with an approach we can adopt in our examination of bioethics that includes a sense of mutuality and equality that the concept of Buddhist compassion was less apt to evoke. Buying and selling organs, donating human eggs, and surrogate motherhood all tend to give rise to relationships that place one person in one type of position and that place the other person in a different and subordinate position. Such a relationship is extremely likely to create a situation in which one person uses his or her own body as a tool for the benefit of another. In the final analysis, this means using that person's body as chattel or as a commodity. To use a person's body as a tool or resource is to treat the human body with contempt, and this is very likely to lead to mutual psychological injury and callousness. This goes against the Buddhist precept against killing in its modern interpretation, that is, the ethical criterion of restraining violence.
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