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Treating Buddhist patients

Enlightenment, the preservation of life and the need for blessings at crucial times are key to treating Buddhists, writes Dr Upali Abeysiri

Buddhism is more a way of life than a religion. There is no belief in a creator god or a permanent soul. Life is but a link in an unending chain of births and deaths and is unsatisfactory, even on the joyful occasions, because of its impermanence. There are many causes that fuel the chain, the chief of which is craving or clinging to sensual experiences and to life itself.

There are two main streams: Mahayana practised in Nepal, Tibet, China, Mongolia, Vietnam, Korea, Taiwan and Japan and Theravada practised in Sri Lanka, Burma, Thailand and Kampuchea. Differences are mainly in the path of liberation and not in the main beliefs.

Buddha as a physician

The Buddha is the physician who diagnosed the universal disease of unsatisfactoriness of life or dukkha that is inherent in all sentient life. He called the aetiology, which is clinging or craving, tanha. The cure is enlightenment or nirvana. The regime described in his doctrine dhamma is the eightfold path or middle path. The steps in the path are generosity, morality, meditation and cultivation of wisdom.

Generosity starts by giving away personal belongings and peaks in giving body parts and even life. The Buddha in his previous lives, while aspiring to be a Buddha, is called the bodhisatta and donated his organs on many occasions, such as giving his eyes to restore the sight of a blind man1. Blood and organ donation is part of the path to liberation.

Buddhist attitudes to health

Morality consists of refraining from:

ltaking life

ltaking what is not given by the owner

lsexual misconduct

lfalse speech

lintoxicants.

Priests or sangha have an elaborate code of conduct, vinaya. This consists of restricting meals after midday, which is now known to be helpful for good health. Most Buddhists are vegetarians, but there is no restriction provided that certain conditions are met. Even the monks are allowed meals after midday on occasion, especially when sick2.

Beliefs

Meditation consists of tranquillity or samatha and insight or vipassana. Tranquillity is also practised in other religions and calms the mind by concentrating on one of 40 objects traditionally prescribed.

Concentration deepens in four stages called jhanas until the mind stays still on the object and appears to have merged with it. It is said to lower the heart and metabolic rates, reduce stress and help in psychiatric conditions. Insight meditation is practised only by Buddhists and leads to wisdom and enlightenment.

Contrary to popular belief, Buddhists do not believe everything is governed by karma, the result of intentional action, whether good or bad. Buddha has stated that phenomena are also caused by the environment (or uthu) genetic (or beeja) and physical laws (or dhamma).

Although the Buddha is not considered a god, Buddhists believe in special powers of the triple gem ­ the Buddha, his doctrine (dhamma) and the disciple monks (sangha). Blessings of the triple gem are evoked in all aspects of life.

This often takes the form of a ritual offering of flowers, light and incense. At the ceremony the great qualities of the triple gem are chanted. Alms are given to the monks, who bless the giver in turn.

Buddhists believe sound waves have the power to affect the mind and body and alleviate suffering and cause healing. Chanting of special discourses of the Buddha as paritta or mantra are used in sickness, childbirth, surgical operations and imminent death. Some Buddhists set in motion wheels on which are fixed scrolls with mantras, instead of chanting.

The practice of healing the sick is one of the positive livelihoods that help progress in the path. This principle led to the emperor Asoka building the earliest hospitals in the world in India in the second century BC3. Buddhists respect and believe in health professionals and do not question their actions. To forgive errors is part of Buddhist tradition and litigation is not condoned.

Birth and death

Following fertilisation, the egg is a living being. The Buddha described living beings as small, medium, large, seen, unseen, close, far, born and not born. Abortion is a negative action, as is the taking of any form of life, and is thought to lead to consequences.

Buddhists believe the last thought is the determining factor of future life, which is why normal practice is to chant parittas or mantras, and if the patient is conscious to preach the dhamma.

At the funeral, a special service is conducted with donation of a death cloth or pansakula to the monks. The merits or punna thus generated is passed on to the dead person in his future life as goodwill thoughts or punnaanumodana.

This is symbolically done: close relatives pour water from a big vessel to an open cup until it overflows, while the monks chant about the impermanence of life. If a person is born in an unhappy plane (there are 32 planes in which living beings are born ­ human and animal are two that we can see), they would use this to escape the unhappy plane.

Culture and ethnicity, not religion, would be the reason for Buddhists to have special needs in medical treatment.

The only special religious preference would be access to monks for invoking blessings.

Health attitudes of Buddhist patients

 · Buddhists are vegetarian ­ take care to offer alternatives to animal-derived pharmaceuticals

 · Blood and organ donation are an important part of the path to liberation

 · During illness or when dying, Buddhists may require access to a monk for blessings

 · Meditation is said to lower the heart and metabolic rate and relieve stress and psychological problems

 · Buddhists respect health professionals and do not question their decisions and actions; litigation is also unlikely

References

1 The Jataka or Stories of the Buddha's Former Lives. Oxford: Oneworld Publications, 1997

2 The Book of the Discipline

(Vinaya-pitaka). Oxford: Pali Text Book Society, 1993

3 Parker G. BMJ 1928;16:39-50

Recommended reading

Walpola Rahula. What Buddha Taught. Oxford: Oneworld Publications, 1997

A Lion Handbook of World's Religions. Oxford: Lion Publishing, 2003

Henepola Gunaratana. Eight Mindful Steps to Happiness.

Ilford: Wisdom Publications, 2001

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