Ask the teachers

Question: My mother died recently after a long battle with cancer. During her final weeks in the hospital, the doctors offered to give her morphine to help ease her pain, but they also advised me that they would gradually need to increase the dosage, and that this would eventually kill her. The decision rested with me. I gave them my permission to administer the morphine.

I would like to know what the Buddhist teachings have to say in this matter. Is this considered an act of compassion or a violation of the vow not to kill? I have also written my own living will, requesting that no extraordinary means of life support be used, and have asked a close friend to assist me in ending my life if I am ever in a vegetative state or suffering from a terminal illness. Does this in any way go against the Buddhist teachings?

Narayan Liebenson Grady: According to the Buddha’s teachings, there are five conditions that must be present to constitute the act of killing. First, there must be a living being; second, there must be the awareness that there is a living being; third, there must be the intention to kill; fourth, there must be the effort made to kill; and fifth, the consequence of one’s action must be death. All of these conditions must be fulfilled for the precept of not killing to be violated.

In applying this to the situation with your mother, we see that there was no intention to kill, there was no effort made to kill, and your mother did not die because of your actions. She died because of a terminal illness and your intention was compassion.

It might help to remember that each precept has two parts to it: the negative and the positive. The negative aspect of the first precept is “I undertake the precept to refrain from killing living creatures,” and the positive is “I vow to practice compassionate action.”

Staying in touch with one’s intentions is a helpful a guide to this precept. Is one inspired by compassionate concern or by unwholesome intentions such as fear, craving, anger, or impatience? In this situation, it is more than likely that your intention was simply to alleviate your mother’s pain.

It is important to observe one’s attitude toward the precepts. It is possible to relate to the teachings based on fear rather than love—we can be overly concerned with the fear of being punished, rather than using the precepts as ways to be more thoughtful and sensitive, and to consider and refine the effects of our actions on others. The precepts are not commandments; they are guidelines that offer ways to be responsive to suffering instead of merely reacting out of our own torments of heart. We are taught that each one of us should honestly contemplate which action is wisest and most compassionate in a given situation and then to take the action that will minimize suffering.

Regarding your second question, as I understand it, living wills are more necessary these days because of the medicalization of dying. What was once a natural process, today may require the refusal of sometimes extremely painful procedures that are meant simply to prolong a life without hope for a cure.

The application of the precepts to modern situations requires great thoughtfulness and consideration. Your last question having to do with asking a friend for help in ending your life, if you are ever in a vegetative state or have a terminal disease, is too complex to answer in this format. For me to respond in a meaningful and in-depth way, I would have to explore with you, in person, whether your intention is based on fear and aversion or on wisdom and compassion. This is one reason for interviews with a teacher; responding to the actuality of life and death with discernment requires deep inquiry—simple resolutions to these difficult questions are not easily arrived at.

The complete article is available in the Winter 2005 issue of Buddhadharma: The Practitioner's Quarterly.