Bio Medical Ethics in Jainism

1.0 Introduction

Ethics is a branch of philosophy. It is the science of conduct that evaluates morality and moral code of conduct logically. Although initially they were practiced for spiritual development and salvation; this concept became in the modern times as an applied field of ethics and when applied in the field of medical practice it became known as bio-ethics.

Bioethics is the ethics for the application of biological Science & Medicine to the living beings. Some bio-ethicists would narrow bioethics only to morality of medical treatment, technological innovations, and the timing of medical treatment of humans, while others include all organisms capable of feeling fear & pain. The problem becomes more complicated due to the explosion of scientific knowledge and technology of the late twentieth century, advances in life support therapies and possibilities of test tube babies, organ transplant and gene therapy to name a few, brought in religious and political forces in the picture. Hippocratic medical ethics of 1960 is not enough to deal with present day and future possibilities. Bioethics is not a new set of principles but the same old ethics applied to a particular realm of concerns.

Religious bio-ethicists have developed rules & guidelines on how to deal with these issues from within the viewpoint of their respective faith. Many religious bio-ethicists are Jewish or Christian scholars. However a growing number of religious scholars from other religions have become involved in this field as well. Islamic clerics have begun to write on this topic. A naturalistic outlook that leads to a rationalistic, pragmatic approach, in general characterizes Buddhist bioethics. In many Asian cultures there are lively discussions on these issues.

As for Jain religion, the twelfth pūrva, out of 14 pūrvas (canonical literature of Jains prior to Mahāvīra) is called Prāṇāvāya and dedicated to science of life. However it is extinct. Still we find description of medical science in Ācāraṅga, Bŕhatkalpa, Pinda Nijjutti, Niṣitha-curṇī etc. Later on a descriptive works by Ugraditācārya called kalyānakāraka were written which are supposed to be based on the Prāṇāvāya. Later on we have excellent works by Samanta Bhadra, Pujyapāda, Hema Candra etc detailing specific aspects of medical science. Besides the entire ethical doctrine of Jains is given in details in various ācāras, like Ācāraṅga, Mulācāra, Ratna Karaṅdasrāvakācāra etc. Overall there are more than 1000 texts written by Jain ācāryas, sādhus, laymen, practitioners etc.

I am neither a Jain scholar nor an expert in bioethics; I have tried to make a sincere effort to bring few points for purpose of discussion on this topic.
 

1.1 Bioethical Issues, which need Attention as per Jain Ethics

• Abortion
• Artificial Insemination
• Artificial Womb
• Assisted Suicide
• Blood/blood plasma (Trade)
• Cloning
• Contraception
• Euthanasia (human, animal)
• Gene Therapy
• Human Cloning
• Human Genetic Engineering
• Infertility (Treatments)
• Life support
• Life Extension
• Organ Donation
• Population Control
• Procreative Beneficence
• Procreative Liberty
• Sperm & eggs (Donation)
• Stem cell
• Suicide’
• Surrogacy

1.2 List of Eminent International Bio-Ethicists Referred

• Abdulaziz Sachedina
• Arthur Caplan
• Barnard Nethanson
• Damien Keown
• James Hughes
• James Rachels
• John Robertson
• Joseph Fletcher
• Julian Savulescu
• Leon Kass
• Peter Singer
• Ruth Faden

2.0 Foundations: Jaina Ethical-Moral Doctrines

Jain scriptures have clearly described the foundations of moral and spiritual doctrines and categorized them according to the status of the person, being a monk, semi- monk or a householder. These moral doctrines will help us derive inferences regarding bioethical issues.

Aristotle equates being ethical to being good and being good is to become virtuous i.e. moral virtue or excellence, as it has to do with passions and actions. In Jainism virtues are not limited to being good morally but are also helpful in spiritual pursuit leading to liberation - mokṣa. Though Jainism originated in pre-historical, pre-modern and pre-technological era, yet we can easily draw inferences from its foundations and spiritual cum moral doctrines and relate them to advances in medicine. There are no direct guidelines in scriptures, however. The cardinal virtue as per Jainism is Ahiṅsā (do no harm or do not cause pain to self and others). It therefore should be the basic guideline for understanding Jain view relating to bioethics. Accordingly Jains said that the motivation or the thought process behind bioethics rather then the actual act is the deciding factor in being ethically valid.

2.1 Social, Personal and Spiritual Ethics or Virtues in Jainism

All virtues / ethics in Jainism are based on its founding principle Ahiṅsā (nonviolence). Rather then separating virtues of body, speech and mind all virtues need to be followed by body, speech and mind together.

2.2 Moral and Spiritual Virtues

2.2.1 Eight Basic Duties (mulaguṇas) for Jainas

As a primary requirement, every Jain must practice the following eight basic duties so that he can exercise self-control and lead a good, ethical and moral life before starting his journey for spiritual purification.

1. Avoiding use of all addictive (mind perverting) substances including but not limited to alcohol, opium, marijuana, cocaine, cigarettes, tobacco etc.
2. Have meatless diet even excluding fish and eggs i.e. be vegetarian.
3. Avoid use of honey.
4. Avoid five non-edible fruits belonging to fig family as growth of infinite microorganism takes place in them.
5. Always use filtered and purified water.
6. Eat before sunset.
7. Always keep attributes of five auspicious beings (Pañca Paramesthis) in mind and when applicable visit temple for veneration and devotion.
8. Compassion towards all living beings.

2.2.2 The Five Vows

The following five vows called vratas are to be followed by all. For laity, these are called Aṇuvratas (small vows) and asking the practitioner to minimize the five ills i.e. violence, stealing, telling lies, owning possessions and adultery in relations; while for the monks the same are called Mahāvratas (major vows) and are to be practiced completely by them all the time.

1. Non-Violence
2. Non-Stealing
3. Truthfulness
4. Non-Possession
5. Celibacy (No Adultery)

Since all ethical postulates of Jainas are derived from non-violence (Ahiṅsā), we give below the four sub divisions of violence, which householder should try to minimize. These are:

• Intentional
• Related to daily life (like food to sustained life)
• Business related.
• Relating to protection of nation, society and family

2.2.3 Vows supporting the miner Vows (Guṇavrata) for Householders

1. Limiting travel
2. Avoiding purpose less on unnecessary activities.
3. Avoiding businesses involving violence.
4. Avoid donating articles relating to violence
5. Avoid involvement with others for gain or loss
6. Avoid unnecessarily cutting trees, start fire, waste water or electricity or pollute the atmosphere
7. Avoid watching or reading or hearing mind polluting sexual or criminal stories/episodes.
8. Limiting use and possession of things of one time use or multiple uses.

2.2.4 Vows that Stimulate Householders towards Monkhood (Śikṣā - vrata)

1. Finer level of limitation of travel.
2. Reading scriptures, leading to meditation, relating to spiritual purification.
3. Giving up partially or completely (i.e. fasting) food on 8th and 14th day every fortnight.
4. Offering charity and food to others

2.2.5. Ten Types of Ethical-Spiritual and Moral Values (dharma)

1. Forgiveness
2. Politeness
3. Straight forwardness
4. Inner and outer cleanliness
5. Truthfulness
6. Self restrain
7. Penance
8. Renunciation
9. Limiting desires
10. Limiting pleasure of senses

All living beings are interdependent (Parasaparograha-jīvānāma) from one-sensed bacteria to fully developed five-sensed human life with analytical and reasoning ability. This elicits feelings of gratitude and responsibility. All living beings are created equal especially with respect to their soul that is capable of reaching liberation - mokṣa.

3.0 Theory of Karma

Jainism defines cause of disease or suffering to be past or present action (Karma). There are eight different types of karmas described.

1. Perception obscuring Karma
2. Knowledge obscuring Karma
3. Deluding Karma
4. Obstructing Karma
5. Age determining Karma
6. Pain and pleasure producing Karma
7. Status determining Karma
8. Body determining Karma

Karmas are bound with the soul, like the files stored in the computer, which are downloaded for writing the text of each and every act of ones mind, speech and body in the present life and each new life.

3.1 Concept of Existence of Soul and Belief of Reincarnation

Jainism believes in the concept of existence of soul as the center of each living being. This soul is polluted with karmic particles from eternity and that this soul will continue to occupy a new body upon death of the present body till it is completely freed of these karmic particles and attains liberation - mokṣa. Therefore in Jainism the importance of body & its health is temporary.

3.3 Concept of Destiny (krambaddha paryāya) and Co-factors (five samavāya):

Destiny is described in Jainism very differently then commonly expected definition. In Jaina concept one is destined to pain, pleasure, disease, disability, death and so on according to previous and present karmas and their fruitions. This destiny is in one’s own control as one’s deeds are as per one’s free will. Therefore indirectly one can control his/her disease & disability. For any act or process to be completed following co-factors will come in to play:

• One’s own efforts (puruṣārtha)
• Proper time (kāla)
• Ability of one’s own soul (upādāna)
• Destiny (niyati)
• Association of a catalyst (nimitta)

4.0 Modern Ethical Issues

The modern day life style, changing paradigms of pleasure has given rise to many issues. Some of these shall be discussed below with Jain view.

4.1 Ethics of Contraception and Population Control

Jainism prescribes vow of limited celibacy for householders and complete celibacy for monks and nuns. For householders 8th, & 14th day of every fortnight (4 days a month) complete celibacy is recommended. Householders are also supposed to observe complete celibacy on Jaina festivals like Mahāvīra Jayanti, Mahāvīra Nirvana Day, Paryuṣana Days. Concept is to teach control of pleasure of senses in order to decrease influx of avoidable karmas.

Secondly each sperm is considered to have life and is capable to produce life. Therefore unnecessary killing of sperms should be considered violence, and therefore limited celibacy not only avoids killing of sperms but also becomes a means of contraception. Similar to rhythm method, contraception as such can be said to be generally acceptable to Jainas not only because of violence towards sperm, but Jainas believe that more the number of children more the attachment and aversions resulting in influx of karmas and related consequences. Therefore population control is indirectly prescribed specially in the interest of domestic felicity and welfare of society, along with minimizing bondage of additional karma with the soul (sanvara).

4.2 Ethics of Womb and Embryo

Methods of artificial procreation

• In-vitro fertilization
• Surrogate motherhood

4.2.1 In vitro fertilization:

When a female is given hormone treatment to stimulate ovarian follicles and eggs are produced, these eggs are surgically removed. Sperms are then added to the eggs and fertilization occurs in the laboratory. Fertilized egg is then implanted in the uterus to grow till delivery of the baby. Sperm for this process of fertilization is usually obtained from sperm bank; some times husband’s sperms are also used.

A recent story of a sperm donor in US was shocking were this medical student’s sperms were picked by at least 20 women and had 20 successful pregnancies, these 20 children found out about this, through internet and had a union. They felt a different type of relationship though they never met the sperm donor. Question is as to which family do they belong? Jain literature while talking of celibacy refutes unnatural sex and polygamy and hence does not support this form of fertilization.

4.2.2 Surrogate Motherhood

The female egg is fertilized in the laboratory using donor sperm or the egg and sperm are taken from couples implanted in the uterus of some other female who is willing to have the child for some one else grow in her womb and deliver the child to give the child away to the donor couple at a price. There is one good side of this process that some one who really wants a child and cannot have of their own, can have with their own egg or sperm. There are rare cases were such child is conceived for the purpose of bone marrow transplant or other such reasons. But I see many issues:

• Purpose of institution of marriage & meaning of family.
• Exploitation of poor women for money.
• Question of successes in full implantation of fertilizes egg or the women naturally got pregnant due to her sexual activity.
• Is it buying or selling children.
• Are we making child a commodity?
• Should the child be told of real mother or what if child finds out later in life?

Jainism probably will not care how the child was brought into this world because this child was to be born regardless of the ways and means. There is mythological story concerning transfer of Mahāvira’s embryo from the womb of Devaki to Trishla in Śvetāmbara tradition, Digambaras question the validity of the story. The question is, ‘Will Jainism consider this to be a physical and emotional violence to the surrogate mother?’

Jain view on artificial procreation would point us to the fact that children are the cause of attachments and aversions leading to influx of karmas and therefore a follower should be satisfied if they can have children by natural means. If not, then they have to accept it as a result of their past karmas and childless experience provides them a chance to accumulate less karmas to improve future and future births. As we see life of a monk or a Sadhvi is of renunciation of family and children for spiritual progress.

4.3 Ethics of Abortion, Birth Defects and Sex Selection

In general Jainism prohibits abortion because of the basic principal of non-violence regardless of the reasons. As there are possibilities of life to be born, killing that life is high level of violence (equal to killing a human being) specially if abortion is done for the reasons of sex selection (elimination of female child to be born). Though statistics are mounting towards shortage of females of marriageable age by year 2010, this issue of sex selection will hopefully disappear.

In case of birth defects Jainism will bring in Karma of that child to be born in play and decide against abortion, stating that if that child has to suffer because of his / her own past karmas, child will live or die of natural causes. Therefore Jainism will not favor abortion for the reason of birth defects.

Should pre-mature delivery of child born under 3.0 lbs or child born with physical and / or mental disabilities be saved? With advent of neonatal intensive care units every attempt is made to save every child at least in western world. These children do grow up with disabilities from slow learning to obvious physical disabilities. Cost of such treatment is about an average of $160,000 per child.

Jainism will definitely support such treatment as every life has same rights to live. As far as disabilities are concerned, Jainism will explain the same on the theory of karma.

4.4 Should Animal Transplant Be Given to Humans?

Five-pound infant baby Fae was given a heart transplant of a seven-month-old female baboon by Dr. Leonard Baily of Loma Linda University in California. Baby Fae survived 21 days.

Animal rights group protested against use of baboon as organ factories. Jaina view is very clear here that life of the baboon is equally precious as the life of baby Fae and that this will be an act of murder, violation of the principle of nonviolence. My personal view is that this is one life sacrificed for saving one life; this is not an experiment on animal to save disease process or entire humanity at large and therefore is not acceptable.

4.5 Ethics of Gene Therapy and Genetic Engineering

With completion of human genome project 100,000 genes were identified and DNA straight in the nucleus and put into sequence gave scientist the ability to read nature’s complete blue print for understanding disease process and may be for creating a human being. Dr. W. French Anderson the father of gene therapy predicts that human genetic engineering will not only profoundly change the practice of medicines, but will impact every aspect of our culture. Down the road doctors will be able to give us DNA finger prints of genes that predispose us to common kinds of diseases, a computer will then be able to read genetic profile, and help doctors some day diagnose diseases before they occur and dispense medical directives. Gene therapy is based on an understanding of the body in which genes provide the system of defence and healing. Genes protect the body, repair damage, and restore it to health. There are two types of gene therapy:

• Somatic Cell Gene Therapy: Implied solely for treatment of diseases like sickle - Cell anaemia, haemophilia and Gaucher’s disease caused by a defect in a single gene.
• Somatic Cell Engineering: Used solely for a possible enhancement rather then treatment like increasing the height or make people brainier.

Jain bioethics will welcome such progress towards setting the stage for:

• A new era of preventive medicines
• New insights to treat patient as a person, having a unique genetic profile
• Affirm belief in Puruśārtha (activity in control of destiny)

Jainism believes in preserving health of physical and mental body in order to pursue spiritual progress while keeping the principal of non violence in the fore front, especially considering unnecessary experiments on animals and humans, but if these techniques are utilized for the betterment of the humanity as a whole and not solely for purpose of financial gain, Jainism will accept it.

Jainism will definitely oppose enhancement gene treatment for betterment of vanity rather than values, as enhancement gene treatment could become an exclusive right of the rich.

Somatic cell enhancement engineering threatens human values especially at our present understanding of such technology is limited and we yet have a limited understanding specially in understanding the passes of thoughts, reasoning, logic and consciousness.
 

4.6 The Ethics of Cloning

On July 5th, 1996 Scottish scientist Ian Willmut cloned a sheep named Dolly, he explained that he had replaced the genetic material of a sheep’s egg with the DNA from an adult sheep and created a lamb that is a clone of the adult. He wanted to create new animals for medical research, and has demised the idea of cloning humans.

Yanagimachi of the University of Hawaii and his team was able to make more then 50 copies of a mouse. Therefore we can see that the technology of somatic cloning is here.

Jains perceive the body of a living being consisting of:

• A physical body: as we see body from outside
• A karmic body: consist of karmic imprints on the soul that get transferred with the soul in to the new body after the death of present physical body.
• A fiery body: consist of the body that gives energy for growth and function a physical body, which also gets transferred with the soul in to the new body.

Jain belief is that the process of cloning is limited to physical body and that individuality of a person is determined by karmic and fiery body that cannot be cloned. A duplicate body does not make a duplicate person the clone’s brain would be far deferent from that of the donor. Identical twins become different individuals though their physical body is identical.

Therefore Jain view is that the science of cloning may have produced a physical body but has not created a living being, a physical body produced through artificial scientific methods or produced through natural means the individuality of that living being will always be a natural process.

Another Jain view would neither approve nor disapprove cloning but would feel that this living being’s physical body was meant to be born while the karmic and fiery body came into this physical body with the migration of soul in this body and cannot be cloned.

4.7 The Ethics of End of Life i.e. Death and Dying. (Sallekhanā)^[1]

In USA a good death is when one has executed a legal document relating to his / her wants and wishes after death. A person is kept alive because of some legality or absence of some such directive. Case of Terry Schiavo in USA is well known, as she was kept alive by artificial means for several years in vegetative state.

Questions of life and death are fundamentally matters of religion philosophy and ethics.

Jain philosophy believes in transgression of soul i.e. soul reincarnates into another living being, until liberation from the cycle of birth and rebirth (mokṣa). Quality of this new life is dependent upon the sum of accumulated good and bad Karmas in the past lives. These accumulated Karmas are carried with the soul into the new acquired body and give appropriate fruitions.

In Jainism value is placed to the soul and not to the physical body, as one will continue to carry the soul into a new body till liberation. Therefore when the physical body can no longer function towards spiritual progress a planed death is prescribed called sallekhanā.

Sallekhanā can be defined as planned detachment with the present body under special circumstances, for the purpose of decreasing the accumulated bad karmas, leading to purity in the thoughts. Person with right perception can only make such decision and per Jain scriptures is distend to liberation within maximum of eight lives. Death thus is a celebration. This therefore is not a suicide. Suicide is when one does a direct and deliberate act with the intention voluntarily to kill oneself for self-regarding motives. Jainism condones suicide.

4.7.1 Circumstances under which Planned End of Life Justified in Jaina Philosophy

• Untreatable diseases where death is inevitable and where all possible medical remedies have been tried.
• Extreme old age where life is physically not livable.
• Irremediable natural calamity like fire, plane crash, drowning.

4.7.2 Process

Depending upon the time available at ones disposal the following process is prescribed.

1. Mentally, physically and verbally giving up:

   • All attachments and aversions (except basic needs) from all family and friends.
   • All anger, ego, deceit and greed.
   • All violence, lying, stealing, passions and sensual desires.
2. Have feeling of equanimity and compassion with all living beings.
3. Analyse and repent of all bad deeds done during the lifetime.
4. Give up feeling of fear, animosity, hatred and unhappiness.
5. Keep silence as much as possible.
6. Gradually decrease the intake of food:

   • From 3 meals a day to 2 meals to 1 meal
   • Then limit intake to milk, juices and water
   • Then gradually water only and finally nothing.
7. Spend maximum time reciting verses.

Jainism tries to answer the questions of physician assisted suicide and death with dignity by voluntarily making the decision to plan Sallekhanā. This is very similar to a non-written directive, after the opinion of physician that there are no possible options of treatment.

Comments

Jain philosophy bases its ethics on principal doctrine of non-violence and so all ethical questions are validates according to the level and intention of the act. Similarly when we analyze any issue, Jains will use the doctrine o multiplicity of viewpoints (Anekānta) to analyze the problem and then come up with conflict resolution.