II. EASTERN THOUGHT

Unlike other species, humans can reflect on death. One response to the mystery and fear humans associate with death is to create systems of religious meaning that give purpose to life in the face of death. A corollary of the fact that people can reflect on death is their realization that it is possible for them intentionally to end life. Religion constrains this possibility in the interest of human survival; only a few exceptions to the taboo against killing humans are allowed. Animals, by contrast, cannot decide to kill themselves and seldom kill members of their own species.

Concepts of death in Asian religions include two basic types: natural—for example, death by disease and old age; and unnatural—for example, death by an accident, by the intention of another person (homicide), or by one's own intention. The latter, here called self-willed death, may be subdivided into three types: (1) suicide (self-willed death out of depression or passion, an irrational and private act); (2) heroic (self-willed death by warriors, and sometimes their wives, to avoid being killed or captured by an enemy, and therefore shamed; or to follow a leader in death because of loyalty); and (3) religious (self-willed death as a rational and public act sanctioned by a religion; for example, in cases of terminal illness or debilitating old age, or as a means to achieve heaven or enlightenment).

Hinduism

THE CONCEPT OF NATURAL DEATH. In no small measure, Vedic (Brahmanical) religion (1500–600 b.c.e.), its sequel now called Hinduism, and other Indian religions (Jainism and Buddhism) inherited views of death from the Indo-Europeans who came to India, probably from eastern Anatolia. Because life expectancy in the prehistoric world was about thirty years, on account of disease, natural calamities, and warfare, people turned to religion for help, performing rituals for health, physical security, longevity, or immortality.

A proto-Indo-European myth about death involved a primordial sacrifice in which Manu (literally Man), the first priest, sacrificed Yemo, his twin and the first king, to create the cosmos, including the realm of the dead. Located to the south, symbolizing warmth, the realm of the dead was described as a paradise where cold, suffering, labor, injustice, evil, darkness, aging, sickness, and death were unknown (Lincoln). According to one Indian version found in the gveda (10.13.4)—the earliest and most authoritative Hindu scripture—Manu sacrificed King Yama, who showed the path to where the forebears of old had gone: The gveda considered this place either the southern world or the highest region—a paradise with light, beauty, and joy. (In later texts, Yama was demoted to preside over a hell; the fetters that once bound him as the sacrificial victim for creation were now used by him to fetter sinners.) In another early Indian version, the Puru asūkta (gveda, 10.90), Man, the sacrificial victim, was bound, killed, and dismembered. His mind became the moon; his eye, the sun; his mouth, the fire; his breath, the wind; his feet, the earth. Henceforth, each sacrifice repeated the cosmogonic one, with animals representing the human victims of earlier Indo-European myths or rituals, to ensure the continued existence of the cosmos. A symbolic reenactment of the cosmogonic sacrifice occurred in the funeral ritual; according to gveda 10.16, different parts of a dead person went to various parts of the universe.

The Vedas prescribed a life of one hundred years, indicating a desire for longevity and natural death. For those who died a natural death, the funeral ritual (śrāddha) would be performed; this would provide them the status of ancestor, ensuring rebirth as a human or existence as a god (hence creating a double buffer against death as annihilation).

Drawing on their pastoral practice of seasonal migration, the Indo-Europeans referred to the dead as traveling along a pathway. In India, the Vedas also referred to the paths of the dead. The straight and easy one ascended to a luminous paradise where the gods lived; the tortuous and difficult one descended to a dark netherworld. By performing sacrifices and funerals, people gained access to the former (gveda, 10.2.3). The most common Indo-European image of the dead following a path involved crossing a river or ocean by means of a ferry guided by a ferryman, the personification of old age, to paradise (Lincoln). During their migrations into India, the Indo-Europeans conquered settlements at fords (tīrtha) to cross rivers. A popular Vedic myth alludes to this: The warrior god Indra killed the native serpent demon Vrtra, thus creating a passage from drought to water, barrenness to prosperity, death to survival, danger to security, darkness to light, and chaos to order (Young, 1980). Hence the Vedic notion of figuratively crossing over dangers to arrive happily on the other shore, to make a way through experience or suffering, and to penetrate the real or the true.

Some of these ideas prefigured a new worldview that led to a dramatic transformation of Vedic religion and the birth of two new religions (Jainism and Buddhism) around the sixth century b.c.e. This period witnessed a great increase in life expectancy. Seeing the miseries of frailty and old age, however, led many people to increasing anxiety over the end of life (Tilak). This gave rise to reflections on old age, the meaning and purpose of life, and ways to move beyond death. The path no longer led to another realm within the cosmos; it now crossed the cosmos (symbolized as the ocean of saṁāra, characterized by the cycles of time, rebirth, finitude, suffering, and ignorance) to liberation.

One of the Vedic texts that elaborated on the ritual, the Śatapatha Brāhmaņa, said the Vedic sacrifice was a boat; the priests, oars; and the patron, a passenger who would reach heaven if no error were made in performing the ritual (4.5.10). Sacrifice also became a way of overcoming death by moving beyond saṁsāra, the cycles of death and rebirth (2.3.3.7). A personification of death demanded what would happen to him. He was told by the other gods that he had dominion over the body but not over immortality, which would occur without him. In other words, the god of death controlled the process and time of dying, but he could not influence those who attained enlightenment because they were beyond the cycles of death and rebirth (10.4.3.1–9).

In the Upanişads (philosophical speculations said to reveal the supreme truth of the Vedas but, from a historical perspective, beginning the transformation of Vedic religion to Hinduism), this extracosmic liberation (mokşa) was characterized by the realization of eternal consciousness, called Brahman. This could be achieved during life; at death the body would disappear forever. Or it could be achieved by a postmortem passage to a supreme heaven where there would be eternal life with a supreme God. Some Upani adic texts spoke of sacrifice leading to the path of the forefathers (pityāna) and thus to rebirth (indicating a demotion of the status of Vedic rituals), whereas others spoke of self-knowledge leading to the path of the gods (devayāna). Still others spoke of a passage to liberation made possible by religious discipline (sādhana) and the guidance of a teacher (guru) leading to supreme knowledge. This notion was expressed as a boat guided by a pilot, ferrying the individual across to the other shore. In Kauśītaki Upanisad 1.4, for example, the deceased proceeded to the river Vijará (literally, "apart from old age", shaking off their good and bad deeds. Their good deeds were transferred to relatives for a better rebirth; their bad ones, to other people. Beyond deeds and dualities, the deceased approached the god Brahmá. Although the human body represented bondage, it also provided the only opportunity for liberation (an argument that was probably necessary to inspire humans to pursue a path to liberation in this life, because they might be reborn as plants or animals).

Closely associated with this development was the law of karma, according to which actions (karma) determined destiny. People were reborn higher or lower in the scale of beings (from high-caste people down to plants), depending on the quantity of good (puņya) or bad (pāpa) karma they had accumulated. With an excess of good karma, they had a temporary vacation in a paradise; with an excess of bad karma, they descended to a hellish realm. But with an extraordinary religious effort (based on knowledge or devotion), they could negate the law of karma by removing the bondage of action and the perpetual cycles of rebirth. Despite the highly individualistic nature of this karma doctrine (people reap what they sow), some versions allowed the transfer of merit from an extraordinary person, or divine grace from a deity, in order to redirect destiny and ultimately achieve liberation.

After the sixth century b.c.e., the idea of crossing over, signified in the term ttha, became associated with various bodies of water; these were sacred places where people could cross over to a better rebirth, a vacation in a cosmic paradise (svarga), or liberation beyond the cosmos (mokşa). To facilitate crossing over, they followed a religious path characterized by action (karmayoga), knowledge (jñānayoga), and devotion (bhaktiyoga); different schools order the three in different ways.

Even today, most Hindus want to die on the banks of the Ganges—believed to be the river of heaven, the nectar of immortality, a goddess, a mother, or even a physician, since this allows them to cross over to liberation. From all parts of India, the dying come to Banaras to live on its banks. They spend their final days in a hospice where spiritual help but no medicine is provided. Hearing the names of the gods chanted continually, they eat sacred tulsī leaves and drink Ganges water, focusing their thoughts exclusively on God. Śiva, Lord of Death, whispers the ferryboat mantra into their ears. After they die, their corpses are taken to the cremation ground, given a final bath in the Ganges, decked with garlands of flowers, and honored as a guest or deity. Then the last sacrifice (antyeşţi) is performed. The eldest son circumambulates the corpse counterclockwise (reversal symbolizing death) and lights the pyre. Relatives are silent, for wailing is inauspicious or even painful for the dead. Finally, the eldest son turns his back to the pyre, throws water over his shoulders to douse the embers, and leaves the pyre without looking back. For the next eleven days, during the performance of the śrāddha rituals, ideally at Banaras or another holy place, rice balls are offered to the dead; on the twelfth day, the departed soul reaches its destination (Eck). It is said that when people die in Banaras, their souls attain liberation—though the idea that transitional souls (preta) are transformed into ancestors (pitr) is also maintained, as are a host of other ideas about destiny.

If dying by the Ganges is impossible, dying at some other tīrtha in India may be a substitute, for the Ganges is said to be there, too, just as all rivers are said to be in the Ganges. And if even that is impossible, simply thinking about the Ganges at the moment of death may influence destiny. Casting the bones that remain after cremation into a tīrtha is also effective. Ascetics are buried, however, because they have given up their ś˛rauta fires (the locus of the Vedic rituals) and their sacrificial implements (Kane). Hindus perform the annual sraddha ceremonies for the dead (offering rice balls to three generations of male ancestors, pitŗs) at the Ganges or any other tīrtha, since this will either sustain the ancestors until rebirth as humans or allow them a long vacation as gods (viśvadeva) in heaven. In short, the Hindu tradition offers a number of safeguards against annihilation at death: rebirth, a visit to another realm, liberation. Individuals can influence destiny or others can help them by the transfer of merit. Gods, through their grace, also may influence an individual's destiny. There is always hope. The sting is taken out of death, for it is said that even mosquitoes are liberated in Banaras (Eck).

THE CONCEPT OF SELF-WILLED DEATH IN HINDUISM. According to the traditional law books, funeral rituals were not to be performed for those who died in unnatural ways. This may have been used as a deterrent against suicide; the Hindu tradition disapproved of suicide, which was defined as killing oneself because of depression, passion, or uncontrollable circumstance. But unnatural death was not always viewed negatively; death by violence (war, murder, or accident) was viewed as powerful, leading to heaven or deification. The type of unnatural death that has relevance for bioethics is the self-willed death, which is given religious sanction. During the late classical and medieval periods, Hinduism came to accept a rational decision either (1) to kill oneself as a way to destroy bad karma, create good karma, and thus attain heaven or liberation; or (2) if liberated in life, to remove the body. Such self-willed death (işţamŗtyu), took many forms. People could walk without food or drink until they dropped dead (mahāprasthāna); bury themselves alive and meditate (samādhimāraņa); abstain from food and wait in a seated posture for the approach of death (prāyopaveśaņa); or jump into fire, over a cliff, into sacred water, or under the wheels of a temple cart. The terminally ill and the extremely old who were no longer able to perform their religious duties and rituals sometimes killed themselves by one of these methods. Such self-willed death was religiously permitted. Sati (a woman's self-immolation on the funeral pyre of her husband) was a variant of self-willed death that produced a surplus of merit that ensured heaven for both spouses. Despite efforts to prevent abuse, it appears that there was some, for by the tenth century, with the Kalivarjya Prohibitions, all forms of killing oneself—except sati—were prohibited (in theory though not in practice).

Some families continued to endorse sati because the alternative was lifelong support for widows or, as in Bengal, a share in the inheritance. After additional criticism by both Muslims and Christians in the following centuries, this practice virtually ended. The Indian Penal Code in 1860 made suicide and abetting suicide crimes; judges interpreted suicide as any form of self-willed death and used that interpretation to stop sati as well as other practices of self-willed death (Young, 1989). There have been isolated incidents since then, including the widely publicized case of Roop Kanwar in 1987. Almost 160 years after sati was declared culpable homicide, Roop Kanwar, an eighteen-year-old Rajasthani woman, performed sati. The government alleged that she was forced onto the pyre and pinned down with heavy firewood. This caused the Indian parliament to pass another law in December 1987 to check the practice. According to the new law, the death penalty is imposed for those who help carry out the ritual of sati; the woman who tries to perform sati may be sentenced to six months in jail; those who glorify sati may be given prison sentences up to seven years; and the government is empowered to dismantle memorials and temples related to sati. Accordingly, her brother-in-law, who lit the pyre, was charged with murder and twenty-two others received lesser charges.

IMPLICATIONS OF HINDU VIEWS OF DEATH FOR BIOETHICS. According to the Caraka Saṁhitā (a classical text on medicine with religious legitimation written about the first century b.c.e.), physicians were not to treat incurable diseases (a policy to establish the benefits of the fledgling science of medicine and to protect the physician's reputation as a healer). This refusal could provide traditional religious legitimation for modern withdrawal of treatment by physicians in cases of terminal disease.

Physicians also were not to reveal the possibility of impending death, unless there was a specific request, so that negative thoughts would not be imposed on the patient that might create bad karma and hasten death. Rather, the process of death should be peaceful and auspicious, because it was the prelude to rebirth or final liberation. The implication of this view for modern medicine is that pain relief provided by a physician might make the dying process peaceful and therefore auspicious in Hindu terms; however, the refusal to inform the patient about terminal illness unless directly asked would be against the modern concept of mandatory truth-telling by the physician and the patient's right to know the prognosis. But another view also existed in traditional Indian religions: a person's last thought influences destiny. In this case, the individual should know of impending death and should not allow anything to cloud the mind. The implication of this view for modern medicine is that pain relief should be given only to the extent that the person remains alert.

Finally, the long tradition of self-willed death, especially fasting to death, in cases of terminal illness or debilitating old age, can be used to give religious legitimation for refusal or withdrawal of treatment in modern India, for it accords with the voluntary and public nature of living wills requesting refusal or withdrawal of treatment and nutrition. Whether it will be used to invoke precedent for active euthanasia depends on the assessment of assistance and whether there had been a slippery slope in the practice of self-willed death. As for the first issue, the Hindu tradition was quite careful to insist on the voluntary nature of self-willed death, though once there was a public declaration and the person could not be discouraged from his or her decision, assistance was allowed, at least in the case of sati. For instance, priests were allowed to hold a woman down during her self-immolation if they had been convinced that the decision for sati had been her own. As for the second issue, the types of self-willed death and possibly their numbers increased over the centuries; since there was criticism of the practice internal to the religion by the tenth century, there was probably the perception of a slippery slope.

Jainism

THE CONCEPT OF NATURAL DEATH. Jainism is an Indian religion that developed about the sixth century b.c.e. The Jains speak of the twenty-four tīrthaṅkaras, such as their founder Mahāvīra, who are the makers of the path or causeway to liberation, enabling people to cross over saṁsāra. The Jain view of death is related to its view of liberation: Because karmas (actions) cause bondage in the cycles of existence (reincarnation), they should be eliminated by fasting and meditation leading to the realization of liberation, the radical autonomy of pure consciousness (kaivalya).

THE JAIN CONCEPT OF SELF-WILLED DEATH. According to tradition, Mahāvīra fasted to death. Henceforth, the ideal form of death for Jain monastics was a "final fast" to death known by different names—bhaktapratyākhyāna, inginī, prāyopagamana, samādhi, pañcapada, sallekhanā, ārādhanā—depending on variants in the practice such as whether there is the assistance of others, whether one dies meditating or chanting, whether the body is to be eliminated by emasculation after initiation, or whether death occurs after the attainment of wisdom (Settar, 1990). Jainism was the first Indian religion to legitimate self-willed death. Initially, the fast to death was to be done only by monastics late in life but before debilitating old age or terminal illness, so that they would be in full control of the meditative and fasting process. Some centuries later, however, the practice was extended to the Jain laity as a legitimate form of death in times of public crisis (natural calamities and military defeat) or personal crisis (debilitating old age and terminal illness).

IMPLICATIONS OF JAIN VIEWS OF DEATH FOR BIOETHICS. Although self-willed death is illegal in India, Jains are arguing for the decriminalization of suicide so that they can restore the traditional practice of fasting to death. They argue that this practice legitimates refusal or withdrawal of nutrition and life-support systems in modern medical contexts for the terminally ill. They also argue that prolongation of the dying process is immoral, because it increases suffering or depletes the resources of the family or community; thus the fast to death is a way to "permit oneself the honour of dying without undue prolongation of the process" (Bilimoria). But since the fast to death was also practiced traditionally in nonmedical contexts, it was not always a way to avoid the prolongation of dying; on the contrary, it was a way of hastening death by the cultural act of fasting when the body was not about to die of natural causes. Although the fast to death was generally understood to be voluntary and planned (and in a category distinct from both homicide and suicide), there were several exceptions. According to some, severely handicapped newborns were allowed to die (bālamarana) when permission was given by parents or a preceptor. In the Bhāva Pāhuḑa Ţīku, bālamarana is classified as: "The death of the ignoramus, or a foolish process of meeting death … Bāla means childish, undeveloped, or yet-to-be-developed, premature and silly" (Settar, 1990, p. 15). It includes the death of infants and those who have an infantile knowledge—who are ignorant, who do not understand the moral codes, or who have a wrong notion of the faith and kill themselves by fire, smoke, poison, water, rope, suffocation, or jumping. While the original classification indicated simply a subdivision of natural death that would lead to rebirth, it seems that at some point in the tradition or perhaps in the modern period, the classification bāla-marana has been reinterpreted. Accordingly, Bilimoria (reporting on statements made by Jain informants) observes that

in principle there appeared to be no reason why a child afflicted with or suffering from the kinds of conditions described earlier should not be given the terminal fast (sallekhanā). Parental permission would be required where there is contact, failing which a preceptor (for instance in an ashram) may be in a position to make a pronouncement. Consent of the recipient is not necessary (hence, a case of nonvoluntary terminal fast). One who has fallen in a state of unconsciousness, again, can be given the fast … even if the person had made no requests while she was conscious, though parents or kin would be consulted. It seemed evident that 'consent,' either of the individual or a proxy, or of the parent, does not seem to be a necessary condition for commending [a] final fast. This would seem to constitute a case of involuntary sallekhanā.… When … asked whether it would be acceptable to inject lethal poison to bring on the impending death, the response was that under extreme conditions where the pain and suffering is unendurable and not abating.… (p. 347)

It is argued by Jains that the history of fasting to death demonstrates that self-willed death need not lead to other forms of self-willed or other-willed death. While it is true that in the past there were a number of safeguards (permission of the head of the monastery, a formal public vow, established ascetic discipline, evidence of courage and will rather than cowardice) and the history of fasting to death was without any extreme abuse in India, there was still a change in the number of groups involved (from monastics to lay people) indicating extension or popularization of the practice. Moreover, the fact that Jainism was the first Indian religion to legitimate a form of self-willed death means that it set an example, which may have inspired legitimation of self-willed death without such careful safeguards by other Indian religions (Young, 1989). In other words, its indirect contribution to a slippery slope in Indian religions cannot be ruled out despite Jain disclaimers. When the Indian penal code made suicide illegal, fasting to death was included. Despite the fact that any form of self-willed death is still illegal in India, there are between six and ten reported Jain fasts to death annually (Bilimoria).

Buddhism

THE CONCEPT OF NATURAL DEATH. The imagery of crossing the ocean or river of saṁsāra to the other shore of enlightenment is used by Buddhists as well as Hindus. Theravāda (one of the main branches of Buddhism, which purportedly continues the early tradition and is still found in Sri Lanka, Burma, Thailand, Cambodia, and Vietnam) metaphorically considers the Buddha's teaching (dhamma) a boat and the individual its pilot. For instance, in Burma, a coin called "ferry fare" is placed in the mouth of a dead person (Spiro).

The Buddha thought often about the nature of death. According to Aśvaghosa's version of his life, the Buddhacarita, the future Buddha was surrounded by royal luxury as a youth, sealed off from the real world in a palace. When he finally ventured into the world, he was overwhelmed by his first sight of a sick person, an old person, and a dead person. These shocking revelations about dimensions of human existence beyond anything he had known so troubled him that he left his life of ease to become an ascetic and search for meaning. Later, on the verge of enlightenment, he recalled his own previous lives, meditated on the cycles of rebirth common to all creatures, and came to understand that all beings are propelled into repeated lives by ignorance and desire. The Buddha spent his life teaching others how to blow out (nibbāna) the flame of ignorance and desire by realizing that all beings are composite and impermanent (subject to suffering, decay, and death). In the final analysis, there was no "person" who died; there was only the process of dying. As narrated in the Mahāparinibbāna Sutta, written down about the first century b.c.e., the Buddha attained final release from his body (parinibbāna) at the age of eighty. After falling ill, he chose the time and place of his departure: Telling those present that all composite things must pass away and advising them to strive diligently for liberation, he meditated with complete equanimity and took his last breath.

Despite the Buddha's emphasis on liberation, subsequent generations of monks and nuns took precautions in case they were to be reborn. The Mulāsarvāstivāda-vinaya (a text composed at the end of the seventh century) describes the monastic funeral: A gong was sounded; the body was taken to the cremation ground and honored; verses on impermanence were recited; merit from this act was transferred to the deceased, suggesting extra insurance in case the monastic was to be reborn; ownership of property was transferred; and cremation was performed. Finally, Buddhist sacred monuments (stūpa or caitya) were worshipped by the living, who then took a sacred bath (Schopen). Laypeople tried to attain a better rebirth by practicing morality, accumulating merit, reflecting on the nature of suffering, and disengaging from activities during old age. They were helped by merit transferred to them through the religious activities of families and friends, especially during the dying process, the funeral, and subsequent ancestral rituals.

As in Hinduism, the moment of death was important, because the final thought influenced rebirth. Even today, according to the popular religion of Burma, relatives chant Buddhist texts or have monks chant the paritta, canonical verses for protection against danger, to calm those who are dying; good thoughts thus arise and lead them either to a better rebirth or to a heavenly reward (Spiro). In popular forms of Theravāda Buddhism, ideas of the soul often replace the doctrine of no soul (anatta). The soul, or ghost, lurks around the house for some days after death and must be ritually fed, placated, and induced to leave the world of the living. Death rituals, ideally involving food and gifts for the monks, not only eliminate the danger posed by a ghost but also allow for the transfer of merit to the dead person, as do rituals performed by relatives on the anniversaries of the death.

Mahāyāna (the other main branch of Buddhism, which originated in India but eventually became popular in Tibet, China, Korea, and Japan) also conceives of the teaching as a boat, but views the pilot as a bodhisattva, a salvific figure who refuses enlightenment until all sentient creatures are saved, graciously steering the boat across to the other shore. Nevertheless, Mahayana maintains that ultimately there is no boat, no pilot, and no shore, since all is nothingness (śunyatā).

In Tibet, monastics meditated on death and simulated the process of dying to attain enlightenment; they also protected themselves against a bad rebirth by certain funerary rituals. Laypeople focused mainly on rebirth and sought help to ensure a good destiny. A spiritual teacher performed the ritual gzhan po wa, by which a disciple went to a paradise. Or the Tibetan Book of the Dead, which describes the journey from the moment of death through an intermediate state to rebirth, was read to the deceased over a number of days. Each of the three stages, or bardos, offered an experience of past karma along with a vision of both peaceful and wrathful divine figures. These provided more opportunities to attain enlightenment (Buddhahood) or a better rebirth, even though each succeeding one was more difficult than the last. Only by recognizing that the deities were ultimately illusory, for all was emptiness (śunyatā), would one attain liberation. These beliefs and practices are still found in Tibetan communities.

In China, Mahayana views of death were reinterpreted in several ways: (1) The notion of heaven was modeled on both Daoist ideas of paradise and its images of Confucian kingdoms complete with palaces, courts, and bureaucracy; the notion of hell was based on Daoist hells and Confucian prisons. (2) Some Chinese argued that the existence of a soul was implied in the theory of reincarnation, in the storehouse of consciousness, or in the Buddhahood of all living creatures. (3) Transferring merit from monastics or relatives became extremely popular. Buddhist monks instituted the annual All Souls festival based on the story of Maudgalyāyana (Mu-lien), who rescued his mother from the lowest hell, as told in the Ullambana Sūtra of Central Asian origin (Smith). Food, clothing, and other gifts were offered to rescue seven generations of ancestors from their sufferings in various hells, and the story was reenacted at Chinese funerals (Berling). (4) Pure Land Buddhism, which became particularly popular in China, promoted, in some versions, an otherworldly paradise attained through faith in Amida (a savior whose grace allows people to be reborn in a paradise called the Land of Bliss until they reach nirvāņa) and calling out his name at the moment of death. According to Pure Land philosophers, this paradise was not real, however, but a product of the mind. (5) Ch'an claimed that the Buddha nature was in all sentient beings, truth was near at hand, and Earth was the Lotus Land; enlightenment was the realization that nothing existed beyond the realm of saṁsāra. Consequently, death meant reabsorption into nature.

Just as Chinese Buddhism had absorbed Daoist ideas of death and native Confucian ancestor worship, so Japanese Buddhism assimilated, in turn, native Shintō views of death and ancestor worship. According to ancient Shintō, death was a curse; the corpse, polluting; and the spirit of the deceased, frightening. Buddhism contributed rituals to purify the spirits of the dead and transform them into gods: Spirits were deified thirty-three years after death and henceforth worshipped with the Shintō kami (entities with a spiritual function that inspire awe). In the seventh century, Empress Saimei ordered that the Ullambana Sūtra be taught in all the temples of the capital and that offerings be made on behalf of the spirits of the dead. The Japanese version of the All Souls festival, called Bon, dates from this time. The association of Buddhism with ancestor worship was reinforced in the anti-Christian edicts of the seventeenth century, which insisted on the formal affiliation of every Japanese household with a Buddhist temple and its death rituals (Smith).

Modern Japanese Buddhism has been primarily associated with death: In addition to funerals, there are seventh-day, monthly, hundredth-day, seventh-month, and annual rituals (Smith). Besides these, the collectivity of the spirits of the household dead is given daily offerings and honored at festival times. The Japanese hold conflicting opinions about where the spirits live: (1) Spirits may live peacefully in ancestor tablets on the altar in the home. (2) As depicted in Nō plays, those who suffered tragedy during life or died violently haunt their graves or former homes. (3) Spirits may have a continued existence as buddhas. Curiously, the dead are referred to as buddhas (hotoke). The Japanese misunderstood the term nibbāna, "to blow out" (in Japanese, nehan). Whereas in Indian Buddhism it expressed the metaphorical idea of blowing out the flames of desire in life and thereby achieving enlightenment, in Japanese Buddhism it was understood literally: People attained continued existence as buddhas when life was "blown out," a euphemism for death (Smith); this may have inspired self-willed death. (4) By chanting Amida's mantra (according to Hōnen) or having faith in him (according to Shinran), spirits enter paradise.(5) Spirits go to mountains such as Osore or Morinoyama with its Sōtō Zen and Jōdo-shin shrines. Many of these beliefs and rituals are dying out. The breakdown of the extended family due to mobility and urbanization has contributed to the lessening of interest in ancestor worship. Now, memory and prayers are for the immediate ancestors; tablets and altars, therefore, are becoming smaller (Smith).

BUDDHIST VIEWS OF SELF-WILLED DEATH. Despite his discussion of the body as the locus of suffering, the Buddha did not endorse self-willed death for everyone. He himself lived out his natural life span. An incident is recorded in the Pārājika (a text of the Pāli Canon, the scripture of Theravāda Buddhism) about how, when some monks became depressed in their meditation on the impurity of their bodies, a sham monk encouraged them—up to sixty in one day—to take their lives or be killed by him so that they could cross samsāra immediately. When he heard about this, the Buddha changed the form of meditation to a breathing exercise and declared that intentionally encouraging or assisting another person to die would lead to expulsion from the monastery. The Buddha also condemned, on the basis of nonviolence (ahimsā), any monk who told people to do away with their wretched lives. It is possible that the Buddha, known as the "good physician," allowed one exception to this general principle: From the accounts of the cases of Vakkali, Godhika, Channa, Assaji, Anāthapiika, and Dīghāvu, it seems that if people were experiencing unbearable pain in dying, they could kill themselves. There is some controversy over such an interpretation, however, for good palliative care had been offered and there were serious attempts to dissuade people from taking their lives. Moreover, neither the Buddha nor the monks gave explicit permission for these monastics and laypeople to take their lives, although the account implies that the act was condoned, perhaps because there were no options aside from physical force to restrain them.

According to an observation of I-Ching, a Chinese pilgrim who traveled to India (671–695), the practice of self-willed death was not popular among the Buddhists in India. Several centuries later, however, its popularity may have grown. In China, some Buddhist monks chose the time, place, and manner of death to bring its uncertainty under their control. It is possible that a story in the Saddharmapuņḑarīka about how the bodhisattva Bhaisajyarāja, who was so dissatisfied with his worship that he set himself on fire, may have inspired the Chinese practice. But the fact that Chinese monks fasted to death in a yogic posture in underground pits (as in the Indian samādhimāraņa), and after death their bodies were smoked, wrapped, lacquered, and installed in temples as objects of great veneration (Welch), suggests a different Indian Buddhist influence. This may have been combined with Daoist techniques to achieve immortality. Finally, it has been argued that self-willed death was popularized in China by a misunderstanding of Pure Land Buddhism, which suggested that people should kill themselves to reach the Pure Land more quickly. Shan-Tao's disciple, for example, jumped out of a tree to reach the Pure Land (Kato).

Some sects of Japanese Pure Land continued this idea. Kūya (903–972) and Ippen (1239–1289), both charismatic leaders among the masses, killed themselves by drowning in order to reach the Pure Land. Before his death Ippen instigated Nyudo to drown while meditating on Amida (a story illustrated on many scrolls). Ippen's death prompted six disciples to drown in sympathy. These examples were further popularized by a tradition of drowning to reach the Pure Land; ordinary people who lost their nerve would be hauled ashore by a rope attached around their waist (Becker). Devotees were told to "Delight in dying" and "Hasten your death" (Kato).

These Pure Land practices inspired more secular forms of self-willed death. There are over forty-five terms in Japanese to describe the various forms of self-willed death; for example, the tradition of parents killing first their children and then themselves to avoid further suffering; the tradition of abandoning old women in distant mountains; and the tradition of joshi or love-killing, also known as oshinjuo or aitai-shi (a death pact between two people, such as lovers who want to attain a happier realm) (Kato). Such practices (which also included death by fasting or fire), collectively called shashinojo, came under scrutiny by subsequent Pure Land leaders who argued that such acts of self-willed death were a denial of Amida's grace.

Some views held by Zen leaders may have been misinterpreted, inspiring self-willed death; Dogen, for example, says to throw away your "body-mind." Zen inspired the samurai warriors and helped them cultivate a stoicism to face death. In medieval Japan, harakiri or seppuku was practiced by warriors to expiate crimes, apologize for errors, escape disgrace, redeem friends, or express devotion to their master by following him in death. These forms of warrior self-willed death are similar to the forms of heroic death by warriors in India. Sometimes seppuku was assisted by a relative or friend. By the Tokugawa period (1603–1867), it involved an elaborate ceremony and, for the famous, burial in a Buddhist tomb.

The popularity of self-willed death in Japan may have been derived in part from ancient Shintō views of death. The lack of a definitive boundary between life and death led to a feeling of intimacy with death and a desire to take refuge in holistic being, understood as kami (nature). This Shintō idea was combined with the concept of the Dao (the transcendent and immanent reality of the universe, represented by vacuity or emptiness because of its being formless and imperceptible) or the concept of the Buddha as nothingness (śunyatā), pure consciousness, or nature. It was also combined with the Buddhist idea of life as suffering and transience, which could be escaped by attaining the Pure Land (Kato).

The Buddhist practice of self-willed death has acquired political significance in the modern period. Known as "falling down like cherry blossoms" or "dying with a smile" (Kato), this way of dying belonging to bushido, the way of the warriors, contributed to the psychology of the Japanese kamikaze pilots of World War II. In Vietnam, the monk Thich Quang Duc's selfimmolation in Saigon (1963) focused world attention on the plight of the Vietnamese under Ngo Dinh Diem's oppressive regime.

IMPLICATIONS OF BUDDHIST VIEWS OF DEATH FOR BIOETHICS. Assessments of the importance of Buddhist views of death for bioethics vary considerably, depending on whether Theravāda or Mahāyāna is the focus and what the commentator thinks about issues such as withdrawal of treatment and euthanasia. Pinit Ratanakul (1988) observes, for instance, that in Thailand the Buddhist principle of the sanctity of life is maintained and self-willed death is not condoned as a rule, even in cases of pain and suffering. Two reasons are given: (1) suffering is a way for bad karma to come to fruition rather than be transferred to the next life; and (2) a person who assists suicide or performs euthanasia will be affected by such an act, since it involves repugnance toward suffering and his or her own desire to eliminate that which arouses a disagreeable sensation. But one exception is allowed: self-willed death when incurably ill, in order to attain enlightenment. These comments suggest that Thailand has maintained a reluctance to endorse self-willed death, in line with its Theravāda tradition, but continues to acknowledge the precedent established by the cases of the terminally ill Vakkali, Godhika, Channa, and others reported in the Palī Canon.

Current Japanese views show a greater acceptance of euthanasia, which is to be predicted, given the history of self-willed death in Japanese Buddhism. It is striking that the modern word for euthanasia is anraku-shi (literally, "ease—pleasure—death"), also a name for the Pure Land, though now some Japanese prefer the term songen-shi (death with dignity). Carl B. Becker, a Western scholar who has discussed this topic with Japanese people, argues that the Buddha accepted or condoned "many" cases of suicide but gives only three examples. He also argues that Buddhists view death as a transition, not an end; therefore, it is the state of mind at the moment of death that is important, not whether the body lives or dies. Those who are not fruitful members of society should be able to die, according to his assessment of Japanese views. Once consciousness (which he takes as brain activity) has permanently dissociated itself from the body, there is no reason to maintain the body, "for the body deprived of its skandhas [the constituents of human existence] is not a person" (Becker, p. 554). In short, all that matters is clarity of mind at the moment of death. We must be careful in using Becker's analysis of the data. In point of fact, the Buddha was very reluctant to condone self-willed death if indeed he did so; it was only a few people who possibly killed themselves with the Buddha's blessing, because they were suffering from terminal illness and because they desired enlightenment. The other examples were simply threats. Becker also ignores the fact that the Buddha called the mere encouragement for others to perform self-willed death—or to provide the means—a deplorable act that would lead to expulsion from the monastery. One traditional commentator on the Parajita includes poison in the list of means. Because Buddhist monks were often physicians in ancient India, it is noteworthy that they were told not to perform abortions nor provide the means or even information to facilitate it; moreover, they must not help a family to kill a physically dependent member. This amounts to a strong position against physician-assisted suicide.

Shigeru Kato is much more cautious in his assessment of the Japanese practice of self-willed death and current Japanese interest in self-willed death, but for different reasons. After noting that some prominent Japanese jurists are advocating the legalization of euthanasia, he reflects on Japan's reputation of being "a kingdom of suicides" and relates the fact that it has the largest number of suicides among all Buddhist countries to its tendency to beautify suicide or absolve it of a sense of wrong. Kato argues that "Human beings have no right to manipulate arbitrarily and selfishly their 'own' lives, which are transiently borrowed and must be returned soon to the holistic Being" (p. 71). He opines that "We can never dismiss this religious holism as an outdated superstition; we must keep it as a brake against the drive toward euthanasia" (pp. 78–79). He also looks to the formation of a better hospice organization in Japan in the 1980s as a way of resolving the "euthanasia problem" through the practice of withdrawal of treatment combined with dialogue and religious and aesthetic care. In the final analysis, however, he is willing to entertain active euthanasia as the right to die "with dignity" and to consider the merits of each case.

Confucianism and Daoism

CONCEPTS OF NATURAL DEATH. Confucian concepts of death are closely associated with ancestor worship, which was practiced as early as the first historical dynasty, the Shang (ca. 1500–1045/1046 b.c.e.). Judging from the written record provided by inscriptions of oracles written on bones, the dead were consulted by means of divination, as if they were living. Everything needed for the next life was put in the tombs of the kings and nobles. Originally servants, entertainers, and others were buried with them. Later, pottery figures were substituted. (In modern times, paper effigies of servants are used.) The cult of the ancestors must also have been practiced by commoners, because it was considered an ancient and widespread practice by Confucius in the sixth century b.c.e.

The ancestor cult was based on rituals, or li. It assumed the continuity of life after death, communication between the living and the dead, the legitimacy of a social hierarchy, and a virtual deification of the ancestors. In his Analects, Confucius upheld the ancient practices, refusing to shorten the period of mourning (XVII.21). Nevertheless, he taught that the spirits should be kept at a distance, so as not to preoccupy the living (VII.20; XI.11). He also thought that mourning rituals should be moderate; they should express grief rather than fear (III.3). Four centuries later, details of the mourning rituals were described in the ritual text Yi Li. Now elaborate, they were to last for three years. During the first year, the eldest son (as chief mourner) had to wear sackcloth, live in a hut outside the home, wail periodically, and eat very little food. Over the next two years, the restrictions were gradually lifted. Even after life returned to normal, though, he reported family business to the ancestors. In Confucianism, as in other patrilineal traditions, the performance of funerary and ancestral rites by the eldest son has contributed to a preference for sons. As a result, female infanticide has sometimes been practiced unofficially.

The Chinese developed two other perspectives on death: a return to nature and physical immortality. The Daoist philosopher Chuang Tzu (365–290 b.c.e.) wrote that life and death were two aspects of the same reality, mere differences of form. Death was a natural and welcomed release from life, and was to be neither feared nor desired. Because individuals were reabsorbed into nature, both birth and death were as natural as the progression of the four seasons. Other Daoists were interested in alchemy, macrobiotic diets, exercises, fasting, and meditation. Besides desiring health, youth, and longevity, they wanted immortality. They had several views of the latter: the physical body would rise to heaven; the "real body," not the physical one in the tomb, would rise; the physical body would go to the Isles of the Blessed, said to be off the northeast coast of China; or the self would emerge from the body at death, like the butterfly from its cocoon, to wander freely about the universe or go to the realm of the immortals.

In Taiwan, the Chinese still practice ancestor worship. They believe that people are related to common ancestors and to each other by an elaborate kinship system in which status is symbolized by the length of time spent mourning and authority is passed through the eldest son. They also believe in two souls: the hun, living in a tablet at the shrine, and the p'o, living in the grave. Both souls may influence the living. Kin meet periodically in the ancestral temple for sacrifices to the hun; the latter are offered wine, food, rice, and first fruits in exchange for health, longevity, prosperity, offspring, virtue, and a peaceful death. They are also remembered by preserving extensive genealogical records and documents written by the deceased. Families visit graves to communicate with or pay respect to the p'o and thus ensure the p'o's goodwill toward the living.

The Taiwanese euphemistically call death "longevity"; after fifty, a person begins to prepare for death by making "longevity clothes" in the Han style of the second century b.c.e., a coffin, and if possible, a tomb. At the time of death, the eldest son of the deceased person eats "longevity noodles" and puts on the "longevity clothes" inside out. Then he puts these garments on the corpse, whose personal name henceforth may not be spoken. Other family members don sackcloth, leave their hair uncombed, and wail periodically (Thompson). The hun is first given a temporary resting place in a paper sword, placed in front of the corpse to receive prayers. After processions to and from the grave, this sword is transferred to a home shrine where the son and relatives offer it food. Finally it is burned, and the spirit is thus transferred to a permanent tablet in the shrine. To keep the p'o, the body's orifices are plugged. The body is then rubbed with an elixir, placed in a coffin, and buried. Sometimes it is placed in a strong, watertight tomb to prevent decay. Coffins and graves are positioned according to exact rules for magical protection. If mistreated, the p'o causes trouble and threatens to become a ghost (kuei). Ritual specialists are then asked to inspect the grave, coffin, or bones to see why the p'o is unhappy (Berling). Daoist and Buddhist priests participate in the rituals of families who can afford them. For instance, priests hold services for seven weeks, during which they chant and pray for the soul to pass quickly through purgatory. Clearly, the Taiwanese try to ensure every advantage for the soul by incorporating practices from many religions.

In Taiwan, death remains associated with the ancestor cult. In the People's Republic of China, by contrast, there have been attempts to reform and even destroy ancestor worship. Communists have argued that traditional funeral rites and customs are remnants of the feudal economy and social structure; those lower in the clan hierarchy are exploited, and women, who cannot attend banquets in the ancestral temple, are excluded. Mourning clothes, moreover, waste cotton; wooden coffins waste timber; graves and tombs waste land; lavish funerals put families into debt; and beliefs in the afterlife instill superstition. Consequently, Communists have recommended the following: simple memorial services for the cadre, factory, village, or cooperative; the replacement of mourning clothes by arm bands; and the introduction of cremation (MacInnis).

CHINESE CONCEPTS OF SELF-WILLED DEATH. Some of these concepts have already been discussed in the section on Buddhism. But it is important to point out that there were practices of self-willed death in the warrior circles of China as well. In fact, it was the obligation, not only the privilege of warriors to practice self-willed death under certain circumstances. This tradition, which had once been found among the elite, became common among the lower classes when warriors began to be recruited from them in the late Chou Dynasty. Later, members of the Mohist school of philosophy, which had links with the lower-class warriors, maintained a tradition of absolute loyalty to their leader. In one incident, eighty-three disciples followed their leader in death (Fung Yu-lan, p. 83).

IMPLICATIONS OF CHINESE VIEWS OF SELF-WILLED DEATH FOR BIOETHICS. According to a report by Shi Da Pu (1991), euthanasia in China, once a taboo topic, has been discussed since the 1980s in the magazine Medicine and Philosophy. After the controversial case of the active euthanasia of a patient named Xia in 1986, which led to a court case being filed by her two daughters against their brother, who had authorized it, the topic was hotly debated in the media. It was also debated by the Chinese Dialectical Institute and Beijing Medical Ethics Academy, which concluded that active euthanasia was permissible for patients with no hope of cure. When the widow of former premier Zhou En-lai wrote that euthanasia was a "proper point of dialectical materialism" in need of discussion, there followed even more public debate. Some argued that it represented the height of civilization because it was a pure act of freedom; others, that it was "the result of the infection in the area of medicine from sick Western customs and morality … sharply against our socialist ethical values" (Shi Da Pu, p. 133). In 1988, a survey of 400 people (health professionals and nonprofessionals) showed that 80 percent were in favor of euthanasia. Both withdrawal of treatment and active euthanasia are being quietly practiced; though they are illegal, no one has been charged. Shi Da Pu concludes that most experts in China think that euthanasia should be regarded as part of the agenda of modernization, that the country should develop appropriate legislation to legalize it, and that the press should be enlisted to spread the dialectical materialist teaching about it.

Conclusion

Four major views of natural death emerge when Asian religions are compared: (1) the cosmic, (2) the existential,(3) the familial, and (4) the natural. Hinduism has focused on the cosmic dimension of death, though it has also included the familial in connection with ancestor worship and the existential because of its long interaction with Buddhism. Buddhist views of death are existential in philosophical texts and some monastic circles; cosmic in the popular religion of both Theravāda and Mahāyāna countries; and familial (in countries with traditions of ancestor worship). Chinese religions emphasize the familial aspect of death, though cosmic dimensions are derived from Buddhism and popular Daoism, along with natural ones from philosophical Daoism.

Some of the Asian religions legitimated self-willed death (and sometimes assistance) in certain circumstances—such as a way to attain heaven or enlightenment, or a way to cope with a crisis such as terminal disease or extreme old age—as an exception to natural death. Although there were attempts to distinguish such self-willed death and assistance from suicide and homicide, respectively, some of the religions decided that the practice had created problems over time.

Each religion has a tendency to assimilate many, often contradictory, views, as if these provide extra antidotes against death. When views are too this-worldly—for example, the desire to eliminate suffering or mundane problems—or too otherworldly—for example, promises of easy heaven or liberation by self-willed death—premature death may occur. People, it seems, need to balance respect for the body and transcendence of it in order to live with health and purpose, thereby doing justice to their full humanity.

katherine k. young (1995)

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Death: II. Eastern Thought

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