Hughes.txt Page:105 JOURNAL OF BUDDHIST ETHICS VOLUME 2: 1995 105-124 RESEARCH ARTICLE BUDDHISM AND MEDICAL ETHICS: A BIBLIOGRAPHIC INTRODUCTION JAMES J. HUGHES Center for Clinical Medical Ethics University of Chicago jhughes@medicine.bsd.uchicago.edu DAMIEN KEOWN Goldsmiths, University of London d.keown@gold.ac.uk Publication date: 1 August 1995 COPYRIGHT (c) 1995 JAMES J. HUGHES AND DAMIEN KEOWN COPYRIGHT NOTICE: ONE COPY OF THIS ARTICLE MAY BE MADE FOR PRIVATE STUDY ONLY. ALL COPIES MADE FOR WHATEVER PURPOSE MUST INCLUDE THIS COPYRIGHT NOTICE. THE TEXT MAY NOT BE MODIFIED IN ANY WAY NOR MAY IT BE REPRODUCED IN ELECTRONIC OR OTHER FORMAT WITHOUT THE WRITTEN PERMISSION OF THE EDITORS. THIS ARTICLE WAS FIRST PUBLISHED IN THE JOURNAL OF BUDDHIST ETHICS. ALL INQUIRIES TO THE EDITORS, JBE-ED@PSU.EDU. ABSTRACT This article provides an introduction to some contemporary issues in medical ethics and the literature which addresses them from a Buddhist perspective. The first part of the article discusses Buddhism and medicine and outlines some of the main issues in contemporary medical ethics. In the rest of the paper three subjects are considered: i) moral personhood, ii) abortion, and iii) death, dying and euthanasia. The bibliographic references appended to the article will be updated periodically (contributions are welcome), and the latest version of the bibliography will be available from the journal's "Resources" directory. TEXT BUDDHISM AND MEDICINE It has not gone unnoticed that the Buddhist aim of eliminating Hughes.txt Page:106 suffering coincides with the objectives of medicine (Duncan et al, 1981; Soni, 1976). The Buddhist emphasis on compassion finds natural expression in the care of the sick, and according to the //Vinaya// the Buddha himself stated "Whoever, O monks, would nurse me, he should nurse the sick" (Zysk, 1991:41). Buddhist clergy and laity have been involved with the care of the sick for over two thousand years. The Indian Buddhist emperor Asoka states in his second Rock Edict that provision has been made everywhere in his kingdom for medical treatment for both men and animals, and that medicinal herbs suitable for both have been imported and planted. Birnbaum (1979) and Demieville (1985) provide good general introductions to Buddhism and medicine. Buddhism appears to have played an important role in the evolution of traditional Indian medicine (Zysk, 1991), and there are many parallels between Buddhist medicine, as recorded in the Pali canon, and //Aayurveda// (Mitra, 1985). There are short monographs by Haldar on the scientific (1977) and public heath aspects (1992) of medicine in the Pali sources. It is likely that as Buddhism spread through Asia it would have interacted with indigenous medical traditions promoting the cross-fertilization of ideas. Redmond (1992) discusses the relationship of Buddhism to medicine from Theravaada and Mahaayaana perspectives and compares Buddhist and Daoist concepts of disease. Discussions of Tibetan medicine may be found in Clifford (1984), Dhonden (1986), and Rechung (1976), while Ohnuki-Tierney (1984) discusses illness and culture in contemporary Japan. Buddhism's holistic understanding of human nature encourages a psychosomatic approach to the pathology of disease (Soni, 1976), something to which Western medicine is now increasingly attuned. It may also be suggested that the Buddhist philosophy of origination in dependence is both a fruitful diagnostic model and a philosophy which encourages a preventive approach to healthcare. However, disquiet has been voiced recently about how "natural" certain forms of traditional Buddhist medicine are - notably the Tibetan "black pill" - some recipes for which specify rhinoceros horn and bear-bile among the ingredients (Leland, 1995). MEDICAL ETHICS Despite Buddhism's long association with the healing arts, little attention has been paid to the ethical issues which arise from the practice of medicine. A small number of monographs provide introductions to the issues and dilemmas which arise in medical practice. These are Ratanakul (1986), Nakasone (1990) and Keown (1995), and these volumes should be consulted in conjunction with the sources listed under the specific subject-headings below. Also relevant is the unpublished Masters thesis by Shoyu Taniguchi (1987a). For general discussions in the periodical literature see Taniguchi (1987b), Mettanando (1991), and Ratanakul (1988; 1990). A useful discussion of Buddhism in terms of the "four principles" approach to Hughes.txt Page:107 medical ethics developed by Beauchamp and Childress (1989) is provided by Robert Florida (1994). The _Encyclopedia of Bioethics_ contains articles on medical ethics in India (Jaqqi, 1987), Asia (Unschuld, 1987), and Japan in the nineteenth century (Kitagawa, 1987). Also on Japan see Umezawa (1988). On medical ethics in imperial China see Unschuld (1979) and on Thailand Violette Lindbeck (1984) and Ratanakul (1988; 1990). The principal issues to be addressed in contemporary medical ethics may be summarised as moral personhood (the question of who is and who is not entitled to moral respect), abortion, embryo experimentation, genetic engineering, consent to treatment, resource allocation, defining death, organ transplantation, living wills, the persistent vegetative state, and euthanasia. Little systematic attention has yet been directed to these subjects by Buddhist practitioners or scholars, and some subjects have not been discussed at all from a Buddhist perspective. The arrangement of the topics below is neither comprehensive nor final. It is inevitable there will be overlap between the sections, and items which appear under one category may contain discussion of issues or principles which have broader relevance. At this time, however, it seems useful to identify three groups of issues and related literature. These concern: moral personhood, issues surrounding life at its beginning, and issues surrounding life at its end. There is insufficient literature on resource-allocation, socio-economic issues, or other questions about general medical practice to justify a category on those topics in this review. There are signs, however, that a Buddhist perspective on certain aspects of medical treatment is beginning to appear, for example Epstein (1993) and Kabat-Zinn's (1990, 1994) integration of Buddhist meditation into medical practice, and the growing literature on Buddhism and social justice, such as Jones (1989) and Sizemore and Swearer (1993). MORAL PERSONHOOD Personhood is both a central problem for Buddhist ethics and Western medical ethics, and consequently a very promising area for a dialogue between the two. The problem for Buddhist ethics has always been why should people act ethically if there is no act, no actor and no consequences of action (Collins, 1982). If there is no self or other, how can there be karmic consequences, responsibility, loyalty, or even compassion? Theravaadin scholars continue to be divided over whether Buddhism suggests different ethics for those who persist in the illusion of self (kammic ethics) and for those who would transcend the illusion of self (nibbanic ethics). The paradoxical unity of compassionate ethics and nihilistic insight into selflessness has been the central koan of Mahaayaana Buddhism. Tantra and Zen suggest that the person who sees that there is no "I" is beyond good and evil. Hughes.txt Page:108 For bioethics, struggles over abortion, animal rights and brain death have brought personhood to the forefront (Nelkin, 1983). Opponents of abortion and euthanasia, and advocates for the disabled and animals, on the other hand, assert that mere humanness or merely being alive should bestow a "right to life." But most bioethicists believe that human beings and animals take on ethical significance to the extent that they are "persons." Some, such as Tooley (1984), would set a standard which would exclude almost all animals, newborns, and the severely retarded or demented. When they specify which elements of sentience and neurological integrity create the illusion of personhood, Western bioethicists begin to sound remarkably Buddhistic: "the awareness of the difference between self and other; the ability to be conscious of oneself over time; the ability to engage in purposive actions" (see, for instance, Fletcher, 1979). At the same time, Western bioethicists have become increasingly troubled by questions about the autonomy, continuity and authenticity of the self. Do anti-depressants create an inauthentic self, or is the self more authentic when its cheerful? Is one respecting a patient's autonomy by respecting the treatment preferences they expressed when healthy, or those they express in the throes of illness? Is it ever possible for a patient to give truly free and informed consent to treatment? The most radical challenge to Western ethics of self- determination came in 1984 with the publication of British philosopher Derek Parfit's _Reasons and Persons_. In this meticulously argued tome, Parfit rejects the existence of continuous selves and concludes that an individual is as discontinuous from itself at some later time as it is from other individuals. Consequently, working for the future welfare of all beings is the same as working for one's own future welfare, since there will be no "I" to benefit in the future. Bioethicists are only now incorporating Parfit's argument. For instance, researchers find that is impossible to accurately anticipate one's state of mind when one is sick or dying, much less when one is unconscious, undercutting the assumption of continuous personhood undergirding "living wills." From a Buddhist/Parfitian perspective, the search for "real" preferences, central to the identity of the person, is a pointless one. With this acknowledgement, it is less troubling to place our trust in our family and friends to make decisions for our future selves (Kuczewski, 1994). More to the point, a Buddhist/Parfitian would encourage citizens to look beyond their personal preferences in dying, which may be to "die with dignity" but may also be to use as many resources as possible to stave off death, and instead participate in creating a health care system that served the needs of everyone in society. Another area of potential dialogue is in the efforts to go beyond Cartesian (and Hindu etc.) mind-body dualism in defining life and death. Over the last twenty years the West has slowly accepted that a "person" is dead if their brain is destroyed, even if the body Hughes.txt Page:109 continues to function. Yet it still troubles many Westerners and Buddhists to declare the permanently unconscious "dead," believing that this is an example of inappropriate mind-body dualism. Other Westerners and Buddhists believe that only a "neocortical" definition of death recognizes the centrality of consciousness and personhood in ethics (Gervais, 1986). More challenging, some Western ethicists have begun to discuss the status of personhood as future technologies make possible the continuity of personality from one body to another (More, 1994). When medical technology offers reincarnation, Buddhist bioethics will certainly flourish. ABORTION Buddhism, like all religious and secular philosophies, focuses on two central questions concerning abortion: (a) when does the embryo or fetus acquire the property which makes termination of pregnancy "killing"?; and (b) is termination of a pregnancy, before or after this point, ever justifiable? While there was a minority tradition in classical Hindu embryology that held that incarnation does not occur till as late as the seventh month (Lipner, 1989), most Buddhist commentators have adopted classical Hindu teachings that the transmigration of consciousness occurs at conception, and therefore that all abortion incurs the karmic burden of killing. Before modern embryology, however, in both Buddhist countries and the West, ideas about conception were scientifically inaccurate, and often associated the beginning of life with events in the third or fourth month of pregnancy (for a discussion of traditional Tibetan embryology, see Dhonden, 1980 and Lecso,1987). Another problem in early Buddhists' embryology is their assumption that the transmigration of consciousness is sudden rather than gradual. Based on the findings of modern neuro-embryology Buddhists today might maintain that the fetus does not fully embody all five //skandhas// and the illusion of personhood until after birth; this is the argument developed by most Western ethicists to defend abortion (Tooley, 1984; Flower, 1985; Bennett, 1989). If the fetus is not yet a fully embodied person, then the karmic consequences of abortion would be even less than the killing of animals, which Buddhism teaches do have moral status. This neurological interpretation of the //skandhas// may be more consistent with Western Buddhism, which often sees the doctrine of rebirth as peripheral or interprets rebirth metaphorically rather than literally (Batchelor, 1992; King, 1994). The second question is whether abortion always generates bad karma, or in Western terms, is it ever "justified." This relates to the debate about whether Buddhist ethics are absolutist, utilitarian or "virtuist," i.e. seeing the good in the development of personal qualities. The absolutist would hold that bad karma is incurred from Hughes.txt Page:110 any act of murder, whatever the justifications. The utilitarian would argue that murder can be a compassionate act with positive karmic consequences, taking into account factors such as the health of the fetus or mother, the population crisis, and the readiness of the parents to raise a child. A virtue-oriented Buddhist would argue that the attitude and motivations of the pregnant woman and her collaborators would determine the ethics of an abortion. Along this line, Tworkov (1992) argues that the karmic skilfulness of an abortion is related to whether the person became pregnant and made her decision to abort without serious mindfulness. From this perspective, aborting a fetus conceived without an effort at contraception would be more karmically significant than an abortion necessitated in spite of contraception. The much discussed Japanese tolerance for, and ritualization of, abortion appears to combine both utilitarian and virtue approaches. The Japanese believe that abortion is a "sorrowful necessity," and Buddhist temples sell rituals and statues intended to represent parents' apologies to the aborted, and wishes for a more propitious rebirth. The Japanese have reached these accommodations consensually, with little debate, and without discussion of the rights of women or the unborn (LaFleur, 1990, 1992). The Theravaadin commentator Buddhaghosa appears to have combined all three views. He held that killing produces karma jointly through the mental effort and intensity of the desire to kill, and the virtue of the victim (Florida, 1991). Since killing big animals required more effort, and was therefore worse than killing small animals, the karma of feticide would be less than murder of adults, and less in earlier stages of pregnancy. On the other hand, for Buddhaghosa, the karma of feticide would be greater than that of killing villains in self-defence. Buddhists have thus far given little thought to the third important question, the connection between morality and law, specifically how, and on what grounds, the state should regulate abortion. Some Buddhists have adopted the stance of many moderates in the West: abortion is murder of a person, but women should have that choice (for instance, Imamura, 1984 and Lecso, 1987). Since most Buddhists have no problem with laws to discourage and punish murder in general, implicit in this position is that murder is either justifiable when it conflicts with bodily autonomy or, since few Buddhists would imprison butchers, that fetuses are closer in status to animals. Clearly there is much room for clarification of the relationship between religious ethics and law in pluralistic societies. Some scholars (such as Ling, 1969, and LaFleur, 1992) have looked beyond the strictly ethical concerns with abortion to examine the cultural aspects of the question. From this perspective it is sometimes pointed out that Buddhism is not "pro-natalist," i.e. does not hold that reproduction is a religious Hughes.txt Page:111 duty - quite the reverse in fact - and does not advocate "family values," at least in the sense that Confucianism did. Buddhist skepticism about family and reproduction was a central cause of Confucian and Shinto persecution. The Sinhalese embrace of contraception and abortion was so enthusiastic in the 1960s, compared to Sri Lanka's Muslims, Catholics and Hindus, that racialist monks began to argue that Buddhists had an obligation to "race-religion-nation" to reproduce. DEATH, DYING AND EUTHANASIA The themes of impermanence, decay and death are omnipresent in Buddhist literature. In many Asian cultures Buddhism is identified as the authority par excellence on matters pertaining to death, and is closely linked to the rites and ceremonies associated with the transition from this life to the next. Buddhist literature emphasises the importance of meeting death mindfully since the last moment of one life can be particularly influential in determining the quality of the next rebirth. General reflections on death will be found in Philip Kapleau's 1972 anthology _The Wheel of Death_ and his 1989 _The Wheel of Life and Death_. Stephen Levine is the author of several books dealing with the subject of death from a Zen perspective while a contemporary Tibetan perspective is provided by Sogyal Rinpoche's popular _Tibetan Book of Living and Dying_, Glenn H. Mullin (1986) and John Powers (1995, Ch.10). James Whitehill (1974) discussed what can be learned from the death of the Buddhist masters, and the development of a corpus of "Great Death" stories of various Buddhist masters is examined by LaFleur (1974). Other writings on death in Buddhism include Smart (1968), Amore (1974), and Bowker (1991). In a 1993 monograph on the subject of death in Buddhism, Becker asserts that the Buddhist tradition, especially in Japan, is very tolerant of suicide and euthanasia. Evidence of this is the Buddha's tolerance of suicide by monks (Wiltshire, 1983) and Japanese stories praising suicide by monks, samurai and laypeople. Becker suggests that Buddhism values self-determination and praises those who decide when and how they will die when they do so in order to have a dignified conscious death. Becker also concludes that the key point is not whether there is still warmth or reflexes (as suggested by some readings of the //Visuddhimagga//) but whether the patient's //skandhas// have permanently left, i.e. the patient is permanently unconscious. In other words, Buddhism would endorse a brain death definition of death. On the understanding of death in Japanese religion see also Picken (1977). A number of issues in medical ethics turn upon the problem of defining death, but few writers have addressed the question of a Buddhist definition of death directly. Only van Loon (1978), Keown (1995), and Mettanando (1991) have argued for a specific definition: Hughes.txt Page:112 van Loon equates death with neocortical death whereas Keown and Mettanando support the "whole brain" criterion. There has been considerable resistance to the adoption of the brain death standard in Japan, both from the public and within the medical profession, due in no small measure to its association with organ transplantation. The brain death criterion allows organs to be harvested with the minimum delay, thereby enhancing the prospects for a successful transplant. Japanese tradition, however, requires the performance of rituals over a lengthy period before an individual is regarded as having passed on, and is also reluctant to countenance plundering the bodily organs of future ancestors. Some commentators suggest that public acceptance of brain death is growing as professional groups and universities develop criteria, and as pressure from potential beneficiaries grows. Also, countries such as the Philippines have raised objections to Japanese patients going abroad for transplants rather than building an organ retrieval system of their own. The best analysis available (in English) of the Japanese situation is Hardacre (1994), but relevant material may also be found in Lock and Honde (1990), Feldman (1988), Becker (1990), and Nudeshima (1991). For discussions of the issue outside of Japan see Ratanakul (1988, 1990), Sugunasiri (1990), and Nakasone (1994). A more positive attitude towards transplantation is revealed in Tsomo (1993). The author surveyed teachers from many different traditions about their attitudes to donation. All were very positive, and emphasized that the corpse is merely an empty vessel, and that to give of oneself is a great thing, and an act of compassion. EUTHANASIA There are no monographs devoted specifically to euthanasia in Buddhism. There are a few periodical articles and the subject is dealt within one or two books. Relevant issues are the distinction between various forms of euthanasia (e.g. "active" and "passive") and the use of narcotics in palliative care which may cloud the mind and interfere with the process of dying (Keown, 1995; Kapleau, 1989; Lecso, 1986; Ratanakul, 1988, 1990). Kapleau's volume _The Wheel of Life and Death_ (1989) contains a short discussion of euthanasia in conjunction with suicide and it is suggested that Buddhism would reject the practice of either. Ratanakul concurs, reporting "a growing consensus among the Thai public that euthanasia (passive or active) is morally unjustifiable" (1990:27). Keown and Keown (1995) explore Buddhist and Christian attitudes to euthanasia and suggest both oppose it for similar reasons. Nakasone, however, is of the opinion that "Evidence indicates that Buddhists would favor the 'right-to-die' position" (1990:76). Jennifer Green's short article "Death with Dignity: Buddhism" (1989:40-41) discusses only the practicalities of funeral arrangements and does not mention euthanasia. Neuberger Hughes.txt Page:113 (1987) is likewise concerned with practical as opposed to moral issues. Euthanasia has been a special feature in two Buddhist magazines, _Raft_, and _Tricycle_. London-based _Raft, the Journal of the Buddhist Hospice Trust_, devoted its No. 2 Winter 1989/90 issue to Euthanasia. Sixteen pages in length it contains short pieces by authors such as Elisabeth Kubler-Ross, Ajahn Sumedho, Dame Cicely Saunders and David Stott, exploring the cases for, against, and in terms of a middle way. A similar range of opinions will be found in the Winter 1992 edition of _Tricycle_, which contains short articles by Patricia Anderson, Jeffrey Hopkins, Philip Kapleau, Chogyam Trungpa, and an interview with author Stephen Levine. Note: not all the items in the bibliography which follows are mentioned in the discussion above. BIBLIOGRAPHY BUDDHISM AND MEDICINE Birnbaum, Raoul 1979. _The Healing Buddha_. Boulder,Co: Shambhala. Clifford, Terry 1984. _Tibetan Buddhist Medicine: the Diamond Healing_. York Beach, Maine: Samuel Weiser. Demieville, P. 1985. _Buddhism and Healing: Demieville's article '//Byoo//' from Hooboogirin_, translated by Mark Tatz. Lanhan, Md:University Press of America. Dhonden, Dr. Yeshe 1986. _Health Through Balance: An Introduction to Tibetan Medicine_. Ithaca: Snow Lion. Duncan, A. S., G. R. Dunstan, and R. B. Welbourn. 1981. "Buddhism", _Dictionary of Medical Ethics_. London: Darton, Longman and Todd. Fenner, Edward Todd. 1982. _Rasayana Siddhi: Medicine and Alchemy in the Buddhist Tantras_. Ann Arbor, Mich: University Microfilms International. Haldar, J. R. 1977. _Medical Science in Pali Literature_. Indian Museum Monographs, 10. Calcutta: Indian Museum. ---. 1992. _Development of Public Health in Buddhism_. Varanasi: Hughes.txt Page:114 Indological Book House. Jaqqi, Q. P. 1987. "India" (Medical Ethics of). In _Encyclopedia of Bioethics_, ed. W. Reich, London: Macmillan, 906-11. Majupu, Trilok Chandra. 1989. _Religious and useful plants of Nepal and India: medicinal plants and flowers as mentioned in religious myths and legends of Hinduism and Buddhism_. Lashkar (Gwalior): M.Gupta. Massin, Christopher. 1982. _La medicine Tibetaine_. Paris: Editions de la Maisnie. Meulendbeld, G. Jan (ed.). 1991. _Medical Literature from India, Sri Lanka and Tibet. Leiden: E.J. Brill. Mitra, J. 1985. _A Critical Appraisal of Ayurvedic Materials in Buddhist Literature (with special reference to Tripitaka)_. Varanasi: The Jyotirlok Prakashan. Ohnuki-Tierney, Emiko 1984. _Illness and Culture in Contemporary Japan_. Cambridge: Cambridge University Press. Rechung Rinpoche, Ven. 1976. _Tibetan Medicine: Illustrated in Original Texts_. Berkeley: University of California Press. Redmond, Geoffrey P. 1992. "Concepts of Disease in Buddhism," in _Buddhist Studies Present and Future_, ed. Ananda W.P. Guruge, Paris: The Permanent Delegation of Sri Lanka to Unesco, 143-159. Soni, R. L. 1976. "Buddhism in Relation to the Profession of Medicine" in _Religion and Medicine_, ed. D. W. Millard, Vol.3. London: SCM Press, 135-51. Unschuld, P.U. 1979. _Medical Ethics in Imperial China. A Study in Historical Anthropology_. Berkeley: University of California Press. ---. 1987. "General Historical Survey" (of Asian Medical Ethics) in _Encyclopedia of Bioethics_, ed. W.Reich, London: Macmillan, 901-6. Umezawa, K. 1988. "Medical Ethics in Japan," _Biomedicine and Pharmacotherapy_ 42:169-172. Hughes.txt Page:115 Zysk, K. G. 1991. _Asceticism and Healing in Ancient India: Medicine in the Buddhist Monastery_. Oxford: Oxford University Press. BUDDHISM AND MEDICAL ETHICS Beauchamp, Tom L. and James F. Childress 1989. _Principles of Biomedical Ethics_, Third ed. Oxford: Oxford University Press. Epstein, Mark. 1993. "Awakening with Prozac: Pharmaceuticals and Practice." _Tricycle_ Fall:30-34. Florida, R. E. 1994. "Buddhism and the Four Principles". In _Principles of Health Care Ethics_, ed. R. Gillon and A. Lloyd, Chichester: John Wiley & Sons, 105-16. Jones, Ken. 1989. _The Social Face of Buddhism: An Approach to Political Activism_. Boston: Wisdom Publications. Kabat-Zinn, Jon. 1990. _Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness_. New York: Dell. ---. 1994. _Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life_. Westport, Conn.: Hyperion. Keown, Damien. 1995. _Buddhism & Bioethics_. London and New York: Macmillan/St. Martins Press. Kitagawa, J. 1987. "Medical Ethics of Japan through the Nineteenth Century," in _Encyclopedia of Bioethics_, ed. W.Reich, London: Macmillan, 922-924. Leland, Charmiere. 1995. "Bear Bile and Musk," _International Journal of Alternative and Complementary Medicine_ 13:16-17. Lindbeck, Violette. 1984. "Thailand: Buddhism meets the Western Model," _The Hastings Center Report_ 14:24-26. Mettanando, Bhikkhu. 1991. "Buddhist Ethics in the Practice of Medicine" in _Buddhist Ethics and Modern Society: An International Symposium_, ed.C.Wei-hsun Fu and S. A. Wawrytko, New York, etc: Greenwood Press, 195-213. Hughes.txt Page:116 Nakasone, R. Y. 1990. _Ethics of Enlightenment_. Fremont, Ca: Dharma Cloud Publishers. ---. 1994. "Buddhism". _Encyclopedia of Bioethics_. London: Macmillan. Ratanakul, P. 1986. _Bioethics, an introduction to the ethics of medicine and life sciences_. Bangkok: Mahidol University. ---. 1988. "Bioethics in Thailand: The Struggle for Buddhist Solutions," _Journal of Medicine and Philosophy_ 13:301-12. ---. 1990. "Thailand: refining cultural values." _The Hastings Center Report_ 20:25-27. Sizemore, Russell and Donald Swearer, eds. 1990. _Ethics, Wealth and Salvation: A Study of Buddhist Social Ethics_. Columbia SC: University of South Carolina Press. Taniguchi, S. 1987a. "A Study of Biomedical Ethics from a Buddhist Perspective". MA Thesis, Berkeley: Graduate Theological Union and the Institute of Buddhist Studies. ---. 1987b. "Biomedical Ethics from a Buddhist Perspective". _Pacific World_ New Series 3 Fall:75-83. Umezawa, K. 1988. "Medical Ethics in Japan," _Biomedicine and Pharmacotherapy_ 42:169-172. BUDDHIST APPROACHES TO PERSONHOOD Chaube, D. B. 1991. _Mind-Body Relation in Indian Philosophy_. Varanasi: Tara Book Agency. Collins, Steven. 1982. _Selfless Persons: Imagery and Thought in Theravada Buddhism_. Cambridge: Cambridge University Press. Harvey, P. 1987a. "The Buddhist Perspective on Respect for Persons". _Buddhist Studies Review_ 4:31-46. ---. 1987b. "A Note and Response to 'The Buddhist Perspective on Hughes.txt Page:117 Respect for Persons'". _Buddhist Studies Review_ 4:97-103. Klein, A. 1987. "Finding a Self: Buddhist and Feminist Perspectives" in _Shaping New Vision: Gender and Values in American Culture_, ed. C. Atkinson, C. Buchana, and M. Miles, Ann Arbor: UMI Research Press. Koyeli, G. D. 1987. "Individual Autonomy in Traditional Indian Thought," _Journal of Indian Philosophy_ 15:99-107. MEDICAL ETHICISTS ON PERSONHOOD Fletcher, Joseph. 1979. _Humanhood: Essays in Biomedical Ethics_. Buffalo: Prometheus Books. Gervais, Karen. 1986. _Redefining Death_. New Haven: Yale University Press. Lizza, John P. 1993. "Persons and death: what's metaphysically wrong with our current statutory definition of death?" _Journal of Medicine & Philosophy_ 18:351-74. More, Max. 1993. "The Diachronic Self: Identity, Continuity, Transformation" (Unpublished dissertation thesis, available at gopher://gopher.etext.org:70/00/Politics/ Extropy.Institute/more.03049* Nelkin, Dorothy. 1983. "The Politics of Personhood," _Milbank Quarterly_ 61(1):101-12. Tooley, Michael. 1984. _Abortion and Infanticide_. Oxford: Oxford University Press. PARFIT'S DECONSTRUCTION OF PERSONHOOD Gruzalski, B. 1986a. "Parfit's impact on utilitarianism," _Ethics_ 96:760-83. ---. 1986b. Symposium on Reasons and Persons. _Ethics_ 96:832-72. Kuczewski, Mark G. 1994. "Whose Will Is It Anyway? A Discussion of Advance Directives, Personal Identity and Consensus in Hughes.txt Page:118 Medical Ethics," _Bioethics_, 8(1):27-48. Parfit, Derek. 1984. _Reasons and Persons_. Oxford: Oxford University Press. BUDDHISM AND ABORTION Florida, R. 1991. "Buddhist Approaches to Abortion," _Asian Philosophy_ 1:39-50. Imamura, Ryo. 1984. "The Shin Buddhist Stance on Abortion." _Buddhist Peace Fellowship Newsletter_ 6:6-7. Jones, K. 1989. _The Social Face of Buddhism_. London: Wisdom Publications. Lecso, P. A. 1987. "A Buddhist View of Abortion," _Journal of Religion and Health_ 26:214-18. Stott, D. 1985. _A Circle of Protection for the Unborn_. Bristol: Ganesha Press. Tworkov, H. 1992. "Anti-abortion/pro-choice: taking both sides," _Tricycle_ Spring:60-69. KEY WESTERN WRITINGS ON ABORTION Bennett, Michael. 1989. "Personhood from a Neuroscientific Perspective" in _Abortion Rights and Fetal Personhood_, eds. Edd Doer and James Prescott. Long Beach, California: Centerline Press, 83-86. Flower, Michael J. 1985. "Neuromaturation of the human fetus," _Journal of Medicine and Philosophy_ 10:237-251. Luker, K. 1984. _Abortion and the Politics of Motherhood_. Berkeley: University of California Press. Tooley, Michael. 1984. _Abortion and Infanticide_. Oxford: Oxford University Press. Hughes.txt Page:119 WRITINGS ON EMBRYOLOGY, REBIRTH AND KARMA "Abortion" in _Encyclopaedia of Buddhism_. Batchelor, Stephen. 1992. "Rebirth: A Case for Buddhist Agnosticism," _Tricycle_ Fall:16-23. Dhonden, Y. 1980. "Embryology in Tibetan Medicine" in _Tibetan Medicine_. Dharamsala: Library of Tibetan Works and Archives. King, Winston. 1994. "A Buddhist Ethics Without Karmic Rebirth?" _Journal of Buddhist Ethics_ 1:33-44. Lipner, J. J. 1989. "The Classical Hindu View on Abortion and the Moral Status of the Unborn." In _Hindu Ethics_, ed. H. G. Coward, J. J. Lipner, and K. K. Young, Albany, New York: State University of New York Press, 41-69. McDermott, James Paul 1984. _Development in the Early Buddhist Concept of Kamma/Karma_. New Delhi: Munshiram Manoharlal. O'Flaherty, W. D., ed. 1980. _Karma and Rebirth in Classical Indian Traditions_. Berkeley: University of California Press. Saksena, B. 1935. "Pali Bhuunahan," _Bulletin of the School of Oriental and African Studies_ 8:713-14. JAPAN AND ABORTION Brooks, Anne Page. 1981. "//Mizuko Kuyoo// and Japanese Buddhism," _Japanese Journal of Religious Studies_ 8:119-47. Eiki, H., and T. Dosho. 1987. "Indebtedness and comfort: the undercurrents of //mizuko kuyoo// in contemporary Japan," _Japanese Journal of Religious Studies_ 14:305-20. LaFleur, W. A. 1990. "Contestation and Confrontation: The Morality of Abortion in Japan," _Philosophy East and West_ 40:529-42. Hughes.txt Page:120 ---. 1992. _Liquid Life: Abortion and Buddhism in Japan_. Princeton: Princeton University Press. ---. 1995a. "The Cult of Jizo: Abortion Practices in Japan and What They Can Teach the West," _Tricycle_ Summer:41-44. ---. 1995b. "Silences and Censures: Abortion, History, and Buddhism in Japan. A Rejoinder to George Tanabe," _Japanese Journal of Religious Studies_ 22/1-2:185-196. Miura, D. 1983. _The Forgotten Child_. Henley-on-Thames, England: Aidan Ellis. Rand, Yvonne, Sensei. 1994. "The Buddha's Way and Abortion - Loss, Grief and Resolution." _Mind Moon Circle_ Autumn:5-8 (also available electronically, filename jizo.zip, original site coombs.anu.edu.au). Smith, B. 1988. "Buddhism and Abortion in Contemporary Japan: //Mizuko Kuyoo// and the Confrontation with Death," _Japanese Journal of Religious Studies_ 15:3-24. Werblowsky, Z. 1984 "//Mizuko Kuyoo//; Notulae on the most important 'New Religion' of Japan," _Japanese Journal of Religious Studies_ 18:295-354. Young, R. F. 1989. "Abortion, Grief and Consolation: Prolegomenon to a Christian Response to //Mizuko Kuyoo//," _Japanese Christian Quarterly_ (Tokyo) 55:31-39. BUDDHISM ON SEXUALITY AND CONTRACEPTION Ling, T. 1969. "Buddhist Factors in Population Growth and Control," _Population Studies_ 23:53-60. ---. 1980. "Buddhist Values and Development Problems: A Case Study of Sri Lanka," _World Development_ 8:577-586. GENETICS AND REPRODUCTIVE TECHNOLOGIES Kimura, R. 1990. "Religious aspects of human genetic information" in _Science, Law and Ethics_, Ciba Foundation Symposium. Hughes.txt Page:121 Chichester: Wiley. Schenker, J. G. 1992. "Religious views regarding treatment of infertility by assisted reproductive technologies," _Journal of Assisted Reproduction & Genetics_ 9:3-8. DEATH, DYING AND EUTHANASIA Amore, R. C. 1974. "The Heterodox Philosophical Systems" in _Death and Eastern Thought_, ed. Frederick H. Holck. Nashville, Tennessee: Abingdon, 114-163. Becker, C. B. 1990. "Buddhist views of suicide and euthanasia," _Philosophy East and West_ 40:543-56. ---. 1993 _Breaking the circle: death and the afterlife in Buddhism_. Carbondale, Illinois: Southern Illinois University Press. Bilimoria, P. 1992. "The Jaina Ethic of Voluntary Death," _Bioethics_ 6:330-55. Bowker, John. 1991. _The Meaning of Death_. Cambridge: Cambridge University Press. Feldman, E. 1988. "Defining Death: Organ Transplants, Tradition and Technology in Japan," _Social Science and Medicine_ 27: 339-43. Florida, Robert 1993. "Buddhist Approaches to Euthanasia," _Studies in Religion/Sciences Religieuses_ 22(1):35-47. Green, J. 1989. "Death with dignity: Buddhism," _Nursing Times_ 85: 40-41. Hardacre, Helen. 1994. "Response of Buddhism and Shinto to the Issue of Brain Death and Organ Transplant," _Cambridge Quarterly of Healthcare Ethics_ 3:585-601. Kapleau, P. 1989. _The Wheel of Life and Death_. New York: Doubleday. Hughes.txt Page:122 ---. 1972. _The Wheel of Death_. London: George, Allen and Unwin. Keown, D. and Keown, J. "Killing, Karma and Caring: Euthanasia in Buddhism and Christianity," _Journal of Medical Ethics_ (forthcoming, October 1995). LaFleur, W. R. 1974. "Japan" in _Death and Eastern Thought_, ed. Frederick H. Holck. Nashville, Tennessee: Abingdon Press, 226-256. Lamotte, E. 1987. "Religious Suicide in Early Buddhism," _Buddhist Studies Review_ 4:105-26. Lecso, P.A. 1986. "Euthanasia: A Buddhist Perspective," _Journal of Religion and Health_ 25:51-57. Levine, S. 1982. _Who Dies? An Investigation of Conscious Living and Conscious Dying_. New York: Doubleday. Lock, M. and C. Honde 1990 "Reaching Consensus about Death: Heart Transplants and Cultural Identity in Japan," in _Social Science Perspectives on Medical Ethics_, ed. G. Weisz, New York: Kluwer, 99-119. Miura, D. 1983. _The Forgotten Child_. Henley-on-Thames, England: Aidan Ellis. Mullin, Glenn H. 1986. _Death and Dying in Tibetan Tradition_. London: Routledge and Kegan Paul. Nakasone, R. Y. 1994. "Buddhism," in _Encyclopedia of Bioethics_, London: Macmillan, 312-318. Neuberger, J. 1987. _Caring for Dying People of Different Faiths_. The Lisa Sainsbury Foundation Series, ed. V. Darling and P. Clench. London: Austen Cornish Publishers. Nudeshima, J. Hughes.txt Page:123 1991. "Obstacles to brain death and organ transplantation in Japan," _Lancet_ 338(8774):1063-64. Picken, S. 1977 "The Understanding of Death in Japanese Religion," _Japanese Religion_ (July) 9,4,48. Powers, John 1995. _Introduction to Tibetan Buddhism_. Ithaca: Snow Lion. _Raft_. 1989. "Euthanasia." _Raft, the Journal of the Buddhist Hospice Trust_ 2 Winter:1-16. Ratanakul, P. 1986. _Bioethics, an introduction to the ethics of medicine and life sciences_. Bangkok: Mahidol University. Sharma, A. 1987. "Emile Durkheim on Suicide in Buddhism," _Buddhist Studies Review_ 4:119-26. Smart, N. 1968. "Attitudes towards death in eastern religions," in _Man's concern with death_, ed. Arnold et al Toynbee, Kent: Hodder and Stoughton, 95-115. Sogyal Rinpoche 1992. _The Tibetan Book of Living and Dying_. San Francisco and London: Harper/Rider. Sugunasiri, S. H. 1990. "The Buddhist view concerning the dead body," _Transplantation Proceedings_ 22:947-49. Thakur, U. 1963. _The History of Suicide in India_. New Delhi: Munshiram Manoharlal. Tsomo, K. L. 1993. "Opportunity or Obstacle: Buddhist views of organ donation," _Tricycle_ Summer:30-35. Van Loon, L. H. 1978. "A Buddhist Viewpoint." In _Euthanasia_. Human Sciences Research Council, Publication No.65, ed. Oosthuizen.G.C., H. A.Shapiro, and S. A. Strauss, Cape Town: Oxford University Press, 56-79. ---. 1983. "Some Buddhist Reflections on Suicide," _Religion in Southern Africa_ 4:3-12. Hughes.txt Page:124 Whitehill, James 1974 "Mystological Death: Some Buddhist Lessons on Dying and Selfhood," _The Drew Gateway_:82-99. Wiltshire, M. G. 1983. "The 'Suicide' Problem in the Pali Canon," _Journal of the International Association of Buddhist Studies_ 6:124-40. KEY WESTERN WRITINGS ON EUTHANASIA Grisez, Germain and Joseph M. Boyle 1979. _Life and Death with Liberty and Justice_. Notre Dame and London: University of Notre Dame Press. Gormally, Luke, ed. 1994. _Euthanasia, Clinical Practice and the Law_. London: The Linacre Centre for Health Care Ethics. Horan, Dennis J. and David Mall, eds. 1980. _Death, Dying and Euthanasia_. Frederick, Maryland: Aletheia Books, University Publications of America Inc. Humphry, Derek and Ann Wickett 1986. _The Right to Die_. London: The Bodley Head. Keown, John, ed. 1995. _Euthanasia Examined: Ethical, Clinical and Legal Perspectives_. Cambridge: Cambridge University Press. Rachels, James 1986. _The End of Life_. Oxford: Oxford University Press.