George was recently diagnosed with amyotrophic lateral sclerosis (ALS), a disease that affects nerve cells in the brain and in the spinal cord, causing muscle atrophy and leading to eventual complete loss of muscle control. The median life expectancy for this diagnosis is between three and five years, but cases are known in which people lived ten and more years after the first manifestation of ALS symptoms.
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However, George is seriously concerned that, at some point, he will be unable to control his body and will become wheelchair-bound and then dependent on permanent ventilator support because his ability to breathe independently will be lost, too. George has been thinking about euthanasia lately and has been trying to decide whether he would resort to it if his state deteriorates. For many people who face this kind of end of life decisions, one of the main sources of support is their faith. However, different religions offer different answers to questions associated with death, life support, and voluntary euthanasia, and the latter may or may not be seen as suicide. To address George’s case, a comparative ethical analysis will be completed for two religions: Christianity and Buddhism.
Exploration of Christianity and Buddhism
In the exploration of a religion or a worldview, it can be helpful to adopt the perspective of worldview questions to which different religions may offer different answers (Shelly & Miller, 2006). The first question is about reality: What is prime reality? In Christianity, the prime reality is God (Kelly, Magill, & Have, 2013) because He is seen as the omnipotent, omniscient, omnipresent, and transcendent, and His existence and will not be fully within human comprehension, but He is the creator and, in some interpretations, the ruler of the world.
In Buddhism, the concept of dharma can be seen as the description of prime reality (Keown, 2016); it is the universal law with which all the natural and observable processes comply, and the purpose of a man is to understand it, i.e. to understand the way things are in order to achieve enlightenment.
The second question is as follows: What is the nature of the world around us? In Christianity, everything that happens is due to the will of God and His intention. In Buddhism, the world lives by the rules that are not understood by humans because perception is deceptive, and judgments are misleading; however, humans can achieve a state in which the truth about the world will be revealed to them.
The third question is about humans themselves: What is a human being? In Christianity, a human being was created by God in the image of God; this means that humans, unlike other creatures, possess souls and the ability to think and create, but they are limited to the conditions over which they have no power, but only God has. In Buddhism, humans are seen as part of the world and as living creatures having sentience and consciousness; they are not the only creatures who have consciousness, but only they can achieve enlightenment.
The fourth question is about death: What happens to a person at death? In Christianity, death is a transition to a different world in which the eternal life of a person will depend on the way he or she lived the earthly life, i.e. a person can find eternal bliss or encounter eternal suffering. In Buddhism, there is a cycle of death and rebirth, and death is seen as a transition to a new life in the same world, and the form of this life will depend on the way the previous life was spent; however, it is possible to break the cycle by achieving enlightenment and ending suffering.
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The fifth question addresses the area of epistemology: Why is it possible to know anything at all? In Christianity, the ability of humans to cognize the world around them is a sign of the special status of humans who were created in the image of God. In Buddhism, it is initially recognized that human perception is limited and illusory, and the judgments which humans tend to make are meaningless; however, it is also acknowledged that humans are capable of being enlightened and understanding the nature of things.
The sixth question refers to ethics: How do we know what is right and wrong? In Christianity, ethics is based on the Holy Bible, which is believed to be a knowledge revealed to humans by God, and the book contains instructions on what Christians should or should not do. In Buddhism, right and wrong are challenging concepts because religion essentially teaches that such an expression of morality is a false duality. However, there are traditional Buddhist concepts of the right vision and right conduct (and the former is a prerequisite for the latter), but some choose to call them wise vision and wise conduct instead. The sources of ethics in Buddhism are the teachings of enlightened humans.
The seventh question is as follows: What is the meaning of human history? In the Christian perspective, humans were exiled from heaven because of their disobedience to God, and their entire history is struggling with the necessity to survive under earthly conditions. The history will end when the messiah comes to this world again, and the kingdom of God will be established. In Buddhism, there is no emphasis on human history; what matters instead is individual cycles of suffering, and the purpose is to break them by achieving enlightenment and not being reborn anymore.
Religious Interpretation of George’s Disease
An important aspect of the comparative analysis is to establish the vision of George’s disease and the reasons for it from the perspectives of the two religions. The Christian vision is that humans need to carry their burdens through their earthly lives because God gave those burdens to them, and there is also the idea that God does not impose burdens on a person that are too heavy for him or her (Kelly et al., 2013).
Concerning the reasons, there is a debate in Christianity whether or not God can punish people during their earthly lives for certain actions; however, in health care from the Christian perspective, no disease can be regarded as punishment or as something a patient deserves. In Buddhism, the question about the reasons for a person to suffer is not even to be asked because the first noble truth of the religion and its essence is that people inevitably suffer (Keown, 2016). The source of suffering is desire, and only enlightenment is the way to end suffering.
Value of Life
Both religions teach to highly appreciate human life. Christianity forbids any forms of taking away someone else’s or one’s own life intentionally (Kelly et al., 2013). Similarly, Buddhism states that any life, not only human, is sacred and should not be taken away (Keown, 2016). Concerning George’s life with ALS, the value of his life is not decreased by his disease in either religion. Therefore, from the Christian perspective, euthanasia is unacceptable.
From the Buddhist perspective, the issue is more complicated. Involuntary euthanasia is absolutely unacceptable (like in most other religions), but the voluntary one may be seen as acceptable for some. Buddhist texts describe monks’ suicides, but it is generally recognized that monks are different in this regard because they dedicate themselves to serving certain teachings and may end their lives in the right state of mind, which is an important consideration in the transition to a new life. In George’s case, a Buddhist would disregard the option of euthanasia.
In its position on euthanasia, Christianity relies on the sacredness of God and the idea that humans do not have the right to decide to take their lives away from themselves because those lives were given to humans by God. However, there is the consideration that, if George is on life support, he would naturally die if it were not for the achievements of contemporary medical technologies, which is why there is a debate whether people have the right to artificially preserve a life that would not last without a ventilator or other methods of life support.
The most widespread position is that life should be preserved by all means, and a decision cannot be made to stop treatment if a patient’s life depends on it. The main euthanasia-related consideration in Buddhism is the state of a patient’s mind. From this perspective, euthanasia is regarded as yielding to suffering and an attempt to avoid it, which is not the right state of mind, and instead, a Buddhist would recommend George to practice acceptance.
Similarly, acceptance of God’s will is what a Christian would recommend, too. What George should do is to be devoted to God and not to blame any person or God for his disease. What is promised to George in this perspective is eternal bliss because one who repents of his or her sins and does not blaspheme will spend the afterlife in heaven. Various spiritual practices can be proposed to George; first of all, he should pray and demonstrate love to his close ones who support him in his disease. Buddhists would suggest meditation as an attempt to achieve the peace of mind and the right state of acceptance necessary to make it through the hardship and face death in a way that will allow being reborn as a healthy and a happy human.
My own beliefs conflict with certain aspects of the Christian and Buddhist perspectives on the end of life and euthanasia particularly. I dread the idea of being a prisoner in my own body (and this is exactly what may await George with his diagnosis), and I cannot judge the decision to resort to euthanasia in case the worst prognosis comes true. However, I think that what Christianity and Buddhism suggest in terms of spiritual practices can be helpful.
Either the patient believes that his acceptance of his incurable disease will help him achieve eternal bliss or be reborn in a healthy body, this acceptance will help him go through treatment and cope with the progressing negative effects of ALS more successfully because it will increase his comfort with care provided to him, and I think it should be part of the nurses’ work to enhance his comfort.
Kelly, D. F., Magill, G., & Have, H. T. (2013). Contemporary Catholic health care ethics (2nd ed.). Washington, DC: Georgetown University Press.
Keown, D. (2016). Buddhism and bioethics. New York, NY: Scholarly and Reference Division.
Shelly, J., & Miller, A. (2006). Called to care: A Christian worldview for nursing (2nd ed.). Downers Grove, IL: IVP Academic.
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