Medical
Ethics AND SIKHISM
Bioethics
is the study of the ethic issues arising in the practice of
biological disciplines such as medicine nursing and other health care
professions including veterinary medicine and other biological or
life sciences.
Increased
capability (for e.g., organ transplant, external life support systems to keep a dying patient alive, genetic engineering to cure a patient of a deadly disease) raises further questions such as, given the capacity, "ought we to do it?" This question does not arise in the absence of capability. Increased knowledge gives rise to specialisation. Should these specialists continue with their value
free research and technology or should they also consider the values
and rights that may be threatened by their researches.
Now
the medicos can no longer confine themselves to their profession.
There is a need for them to evaluate their actions, to consider the
ethical implications of their actions. The doctor- patient
relationship can no longer be strictly based on the Hippocratic Oath.
The rights of the patients as well as the rights of the doctors need
to be reconsidered in the light of the present-day advances. The
dignity of human life and therefore prolongation of human life at any
cost is being reconsidered. Increased capability raises the question
of rights of the dying patient over his body,and also rights of the
society or community to which he belongs, over him. Till now, we have
been discussing the right to live but now, the right to die is also
being stressed.
In
this paper, I shall consider as to what would be the attitude of
Sikhism towards some problems that have arisen in medical ethics.
Euthanasia, suicide,abortion and organ donation. These issues are
based on the concept of right to one’s body. It can be argued
that since I have a right to my body I have a right to opt for
putting an end to my life, or donating an organ of my body to benefit
someone else. Similarly, a woman may say she has a right over her
body and that she does not want to carry the fetus in her body, for
whatever reason. Sikhism, does not accept that I have a right over
my body.
The
ethics in Sikhism stresses more on duty. My body is given to me by
God, and I have a duty to preserve it and similarly, I have a duty to
preserve the body of others. Thus accepting the principle of sanctity
of life, I do not have any right to destroy or harm my body or the
body of anyone else. The neglect of one’s body or another’s
body is a sin according to Sikhism.
Euthanasia:
With
new methods of treatment and advances in medicine, doctors are able
to prolong life of a large number of people. In most cases it is
presumed that prolongation of life is in the best interests of the
patients and this is also considered as a duty of the doctor.
However, the problem comes up when a patient denies treatment and
does not want to be kept alive artificially.
Euthanasia
is derived from Greek words ‘eu’ meaning good and
‘thanatos’ meaning death. Thus euthanasia implies
good death. It means, “the intentional termination of life by
another at the explicit request of the person who dies”. It is
also referred to as mercy killing. Euthanasia is usually resorted to
in case of physically unfit or ill people who feel that they would
like to die with dignity not being dependent on others or who desire
a painless death.
The
justification usually given is that the patient is in terrible agony
and pain. He is going to die any way because he is suffering from an
incurable disease. He is not able to bear the pain and is feeling the
loss of dignity as he is totally dependent on others. He wants a
peaceful painless death. Therefore, if the patient is himself asking
to be killed, the doctors should consent and remove him from this
agony.This is called active euthanasia.Active euthanasia
involves causing death of a person , through direct action, in
response to a request from that person.In passive euthanasia,the
death of a person is hastened by altering some form of support and
letting nature take its course.
One
may respond to such a situation in different ways. These are
variations between cultural and religious traditions as to when the
culmination of life is considered wrong. If we see historically, the
Greeks did not believe that all life is precious and therefore should
be preserved at all costs. In Sparta for example it was required by
the law that deformed infants be put to death. It was considered
better that they die rather than they live an unhappy life. If the
body was considered useless for service, one should rather free the
struggling soul.
As
opposed to such tradition Sikhism believes that, this body is given
to man by God. Suffering in this life is under God’s Will and
as a result of one’s own Karma. Administering euthanasia is not
giving comfort but rather putting an end to one’s life and
suffering will continue in the next form of life, maybe
human/non-human.
Another
argument given against euthanasia is that better quality of life is
not dependent on physical condition but mental and spiritual
condition as well. Pain and sorrow alongwith happiness and comfort
are both part of our life. They are like clothes that man wears.1If
a person is in pain this does not really change or alter his inner
self. It is only the dress that has been changed . So there is no
reason to contemplate euthanasia.
One
may come across a patient who may be physically miserable yet
being a spiritual person having faith in God’s ways, he may not
really be suffering as thought by others. Therefore, euthanasia in
such a case would be a crime. He would say,we can mentally
alleviate a patient’s suffering by ‘Naam’. Naam
would give him the strength to bear physical pain. Euthanasia may end
suffering temporarily in this life, however it will not end suffering
in the next life. Suffering is bound to occur.It may only be
postponed temporarily.In the case of patients in the persistent
vegetable state(PVS) one may argue as to how can they be taken out
of this agony by Naam,for they are not even conscious. Here also Naam
can do wonders.After all it is God who has created this body.He can
always cure the person of this incurable disease .
Feticide
According
to the slippery slope argument “If you take step A, as a result
of the sticky sequence of events, step B will necessarily or very
likely follow, B is clearly not acceptable. Therefore you must not
take step A”2.
Between an embryo and the newborn infant there is a continuous line
of development. We cannot have an arbitrary cut off point and say
that at this stage of development of the fetus, it can be aborted but
not before. If feticide is accepted it will lead to acceptance of
infanticide according to the slippery slope argument. Therefore
feticide is unacceptable at any stage because of the consequeces it
will lead to.
Another
more important reason against feticide is that the embryo itself is
living. Therefore whether it will by consequence lead to infanticide
or not, feticide involves killing of a living embryo. This is a
forbidden act in Sikhism.
If
a fetus is genetically screened and is found to be prone to a severe
defect as he has defective genes,should we abort the fetus or let it
be born and then suffer, or should it be aborted? The defective genes
are due to the bad karmas of the child and parents etc. By aborting,
we are preventing the karmas from taking fruit. Do we have a right to
do that? Shouldn’t we leave it to God to decide whether such a
child should be born or should die while it is still in the fetus? By
aborting, can we really put an end to the karmic effects of the
fetus? If aborted, this fetus would take birth again and bear the
fruits of his karma?
Organ
Donation
Sikhism
is based on the concept of service to the community. A Sikh should
always be ready to help the needy. Thus, if by donating his blood or
an organ, he can save the life of another person, it is in the
service of humanity which is recommended. This would prolong the life
of another person.There are certain ethical implications here
too.Suppose a person donates his organ not out of a feeling of
service but due to a dire need of money which he may get from the
recipient of his organ.This sort of organ donation is really
questionable ,for he is using his body as a means and is not
recognising the intrinsic worth of his body.He rather thinks that he
has a right to his body and therefore donates it.
Similarly
a person ,say the wife of a patient who needs a kidney may be forced
by social pressure from society ,or her in laws to donate her kidney
to keep her husband alive.This is a case of involuntary organ
donation and will not be accepted as ethical .
We
may grow human clones or genetically modify animals so that their
organs can be transplanted into humans in need of them.This is not
permissible. The human clone is grown and when there is need, the
needed organ would be removed and the cloned human or the animal
would be left to die. In such cases, the life of the clone or the
animal is being disrespected and therefore this would not be
permissible according to the Sikh Scripture. We cannot use another
living organism in order to serve our personal purposes.
We
can definitely consider transplantation of organs from a person who
is in a persistent vegetable state and had given the consent to use
his organs if at all he were to go in a comatose state or after his
death.The latter would be a case of cadaver transplantation and here
there would not be any adverse ethical implications.
The
question of reverence for life presupposes the value of life and the
attitude towards death. Only in light of the concept of death can we
discuss the issue of sanctity of life or reverence for life.Sikhism
accepts the concept of martyrdom, and a Sikh is supposed to be
prepared for death and should welcome death.However, euthanasia,
suicide, feticide are not permissible within Sikhism. Martyrdom is
not suicide. It is a case of sacrifice of one’s life. Suicide
is committed by a mentally ill and frustrated person, whereas, in
sacrifice, a man is perfectly normal, not a coward, but is rather
courageous, is ready to accept physical torture and death, for some
goal, aim , purpose or a higher and nobler cause.
In
Sikhism, death is not looked down upon. Rather, death is welcomed.
Saint Kabir mentions in Sri Guru Granth Sahib3
that the death of which everyone is afraid, I welcome it. For, it is
only on death that one meets one’s Lord. Similarly, if we see
historically, the fifth and the ninth Guru welcomed martyrdom and
preferred death rather than live a life without dignity and honour.
Same is true of the Sikh martyrs over a period of time. But then,
does this imply that these Gurus, martyrs and saints did not value
human life, or their aim was an early death, or did they despise
human life? Just the opposite was true. In fact, the Sikh Gurus
enjoined every Sikh to look after his body, for, God dwells therein.
Also, it is only while we are in this body that we can attain
liberation. Thus, this life is said to be having utmost value. If
human life has intrinsic worth, it is a gift of God. (a
presupposition of all theistic religions) we donot have the right to
neglect it or to take life.
The
principle of reverence for life is not only confined to the human
sphere. Sikhism believes in sanctity of all life forms and therefore
Xenotransplantation (transplantation of the organs from animals into
humans), cloning, genetic engineering etc. which treat other life
forms as a mere means to meet human ends are also questionable.Next I
shall discuss the position of Guru Granth Sahib on Genetic
engineering.
SriGuru
Granth Sahib and Genetic Engineering
Genetic
engineering is an awesome power. It promises relief from various
diseases and along with it, it also promises new forms of life.
Rather it promises an entirely new type of planet. Life forms will no
more be the same. Human beings and all other life forms will be
transformed both intentionally as well as unintentionally. The
utopian planet earth is no more going to be a fiction. It is very
fast becoming a reality. The world is being redesigned. An enormous
amount of money is being pumped for the genetic engineering research
projects. It is the transnational corporations, which are controlling
and directing research. They are hardly concerned about the ethical
implications of genetic engineering. Their major motive is profits.
Genetic
engineering places in human hands the capacity to redesign living
organisms. These organisms are the result of three billion years of
evolution. Erwin Chargoff, an eminent geneticist also called the
father of modern microbiology questions:
Have
we the right to counteract, irreversibly, the evolutionary wisdom of
millions of years, in order to satisfy the ambition and curiosity of
a few scientists?…..The world is given to us on loan. We come
and we go and after a time we leave earth and air and water to those
who come after us. My generation, or perhaps the one preceding mine
has been the first one to engage, under the leadership of the exact
sciences, in a destructive colonial warfare against nature. The
future will curse us for it4.
Current
technology may allow us to produce custom-made organisms, for e.g.
bacteria, that clean up oil spills but then should we pursue such a
technology? Are we so inconvenienced by the present state of the
earth that we need to make changes on it by creating new forms of
life. The core issue behind the ethics of genetic engineering is that
is it right to change the nature of life on earth to suit man’s
desires better? Are we superior to animals and the rest of the
creation? Are we answerable to no one? If we are not fundamentally
different, do we have the right to meddle with evolution? If we are
accountable to God for our actions, should we risk insulting His
creation by trying to better it?
The
above questions about genetic engineering are all intrinsic concerns.
The extrinsic concerns about genetic engineering evaluate the
benefits and risks of genetic engineering. Theologians hold that as a
matter of fact, genetic engineering is intrinsically wrong. Genetic
engineering is unnatural. Anything that is going against the laws of
nature is questionable and immoral. ‘Nature knows best’
and the evolutionary processes of nature have a well-established
track record. Genetic engineers are gambling with their unproven
introductions. In their gamble they may cause disastrous changes.
The
intrinsic arguments against genetic engineering are mostly
theological. According to Guru Granth Sahib, nature is created
by the will of God. He knows best and He has created everything
complete. He has left no process incomplete5.
He has created the world and He sits and enjoys it.
Granted
that from within the religious matrix, we accept that man is superior
to all other forms of creation, yet in no way does he have the right
to exploit nature. Since the earth is created by God, everything has
the right to live, exist and flourish. We are not within our rights
to destroy or exploit any species or any part of the ecosystem in
general. Since we have not created it, we do not have the right to
destroy it or make any species extinct in it.
After
all there is a Divine Purpose, a Divine Design behind nature. We are
not aware of this design, of this Cosmic Purpose. The day we are
self-realized, we would understand this Design and we would never
think of interfering or making any changes in this 6.
He alone has created nature and He alone knows it, understands it.
We
are permitted to use the natural resources but not to exploit them
for, they are not merely meant for our use but also for the use of
the future generations. We do not have the right to tamper with
nature. If God has created it so that we, the existent generations
can enjoy it, the future generations are equally valuable in God's
eyes. In fact nature has not been created merely as a resource for
man; it has its own inherent worth. The whole ecosystem is made in
such a way that one species depends for its survival on another
species7.
However man is not permitted to exploit or tamper with nature beyond
his basic requirements.
The
argument against genetic engineering in its simplest form is as
follows:
‘Nature
and all that is natural is valuable and good in itself; all forms of
genetic engineering are unnatural, they go against nature and
interfere with nature, particularly in the crossing of natural
species boundaries; all forms of genetic engineering are therefore
wrong.’8
We
cannot isolate genetic engineering research from theological
concerns. While discussing theological concerns we could discuss from
two points of view. One would be from the point of view of religions,
which presuppose that although nature is God’s creation yet man
has been given the power to do whatever he wishes to do with it and
to use it the way he wants to.The second perspective is that of the
Sikh scripture,viz.,nature is God’s creation and we have no
right to interfere with it or to make attempts to improve it..
According
to the Sikh scripture the world is the creation of God. God creates
everything good. There is nothing created which is bad. Therefore the
world as it is, in other words the natural world is good. Thus
whatever is the case is good. If we go against nature, our action is
bad for we will be making changes in nature. These changes would
imply that the world is not as it was created and therefore
theologically it would be bad.
This
interpretation differs from the semitic viewpoint. The world was
good, but due to the Fall, there are changes that have occurred and
nature is no longer good as it was. As per the Baconian
interpretation of the genesis, man must gain mastery over nature,
know its secrets and control it; ‘he must regain his dominion
over nature, which was given to him by Divine bequest’.
Thus
nature also is to be respected. Nature does not have merely
instrumental value. Nature in itself is also having intrinsic worth
as was said by Guru Angad. "This world is the house of God, and
God resides in it”. If it is the house of God how can I, as a
spiritual being, having self-realization as the goal, be unmindful of
nature, and how can I afford to disrespect nature? If I want to
realize my self, this is possible only if I love God's creation.
Without love, God cannot be realized. As Guru Gobind Singh has said,
"Jin prem kio tin hi prabh paeo."9
Only those who love God's creation can attain God or Moksha or
self-realization. Loving God's creation does not imply loving only
men or the biosphere but the ecosphere in toto, for, the ecosphere
and human beings, everything is the house of God and God resides in
it. As Guru Amardas has said,10
“This world, which you are seeing, is the form of God, and has
come into existence only due to God's blessings”. If nature is
created, blessed by God and is the house of the Lord, I have to love
and respect it and recognize its independent intrinsic value. When I
recognize the intrinsic worth of nature, I will not think of
tampering with it.
If I am not allowed
to tamper with nature, how can I justify genetic engineering? If we
start playing with genes, we are ‘playing God’. We are
very finite beings knowing only our present and past. Our future too
is unpredictable. It is not possible for us to know the long-term
consequences of our actions. When we genetically engineer organisms,
we are trying to create new organisms, a new type of a world. We
think we have the power to create. Do we really have this power? We
must be humble. We are like a speck of dust. Guru Nanak says that we
are finite beings and cannot know the limit of God. If we cannot know
God, how can we ‘play God’? How can we create?
Sikhism
questions genetic engineering for it involves not only exploitation
of animals but exploitation of the entire nature.
Heidegger,
“in technology we make objects according to some blueprint that
we determine. We design things to satisfy our purpose rather than
allow our purposes to be affected by, and find creative expression
through, the qualities of the objects themselves.”11
Today
we are not satisfied with mere artifacts designed to serve our
purposes. We are now aiming at nature, animals and humans designed to
serve our purpose. How arrogant and selfish we have become. We want
to make human, plant and animal artifacts too. By doing this, the
biodiversity and ecodiversity would all vanish. We would merely be
finding copies of humans, plants and animals when we clone.
And
isn’t biodiversity in itself also valuable? Doesn’t man
also want diversity, change? Then, why are we cloning genetically
engineering organisms? We are heading towards monoculture. God on the
other hand has created so much of biodiversity that no one
cell/organism is like the other.12
This itself is a fascinating phenomenon. It is this diversity which
brings in us admiration of nature. This is what takes us to a state
of bliss and wonderment. It elevates our soul. It is a pity that we
are going all out to destroy this diversity in the name of progress.
Thus
genetic engineering is questionable because it goes against the very
basic principle of the Sikh scripture, i.e., the world as it is
created is best. God knows what is right and wrong. He has designed
the laws of nature, creation and dissolution. Man has no right to
interfere and bring about genetic changes.
The
tension that we face when we have a severely retarded child who may
be curable by genetic engineering is difficult to resolve. Should we
accept him as he is, as a gift of God, with whatever abilities,
disabilities or should we view our child as an asset to be acquired?
If I accept the latter then I would want to genetically engineer him
at whatever cost (economic, or may be damage to the global humanity
or damage to the ecosystem) and make him a perfectly healthy, genius.
But if I accept the will of God, I would accept every condition as
created and willed by God. Especially, if I believe in the law of
karma, then whatever my child is, he is the result of his and my
previous karmas. Do I have the power to negate that effect? Seen from
the Sikh point of view, I cannot really undo the karmic effects. It
is not within my control.
Doesn’t
genetic engineering open up the possibility of negating the karmic
effects? By genetic engineering, I can make my child disease free.
How would the law of karma operate under such circumstances? While
inserting a healthy gene, during gene therapy, it is possible that
the genetic makeup of the child may be disturbed causing some other
incurable ailments or abnormalities in the child. Would we have then
negated the karmic effects? Yes apparently it does appear that we
could negate the karmic effects. Genetic engineering seems to be a
magic potion for all the ailments. Is it really so?
We
are only aware of the positive effects of genetic engineering. We do
not realize that though we may treat the patient of that disease but
we may be making him amenable to some other disease, which may even
be more dangerous, for as we know genetic engineering is not and
cannot be an exact science.
Sikhism
would at no stage accept that man could be co-creator. God is
infinite. Does He need the help of man to create a better world? Does
God not know what is best for us? This world is created under the
Will of God and it is enjoined upon every Sikh to accept the Will of
God. We should not try to equal God, for we can never really do so.
He has created us! He is all-powerful. We are very small beings, who
have been given an intellect, that too by God and how can we try and
match Him or create like Him.
According
to Sikhism, the world is made by God, according to His Will and
desire. The imperfections that are there in the world, in human as
well as the natural world are all under the Will of God. If He so
desires, he can himself make this world absolutely perfect. He can
Himself root out the imperfections. He does not require man’s
help for this purpose. Thus we cannot justify genetic engineering by
saying that by genetic engineering man will be able to root out all
suffering and restore creation to its full glory. It is really
unacceptable or a contradiction to presuppose an omnipotent God, who
is the Creator of this world, and at the same time hold that man can
restore the creation to its full glory. If man, who is created by
God, can root out suffering, can’t God do it? Is it really
possible for man to root out all suffering or is it that he would
actually make us much more miserable than what we are now?
We
may perhaps justify the imperfections by referring to the theory of
Karma. In that case the question that may arise here is that what
karmas would one attribute to the imperfections found amongst
animals, plants and inanimate nature? It is worth mentioning that
according to the Sikh philosophy, which believes in the
transmigration of the soul, the soul does not merely acquire human
form. It also transmigrates into animals, plants, trees, rocks and
mountains.
Kaee
janam Bhae Keet Patanga.Kaee janam gaj meen kuranga…
…Kaee
janam sail gir parea13
--Which means this soul has taken
the form of insects, kites for several lives…the form of
elephant and fish for several…birds and snakes…trees.
This soul has several times also taken the form of stones and
mountains. Thus we reap the fruit of our karmas not only in human
life but also in plant or animal life. This would explain why animals
have imperfections and why they suffer.
I
have shown that genetic engineering goes against nature. It goes
against the God made world. It brings about an ego in man that he can
equal God, that he can improve upon the God made world. Genetic
engineering shows contempt of nature as it is today. Its aim is to
transform nature according to human desires. This goes against the
basic tenets of the Sikh religion in particular. Nature has the
right to live and flourish. It has its own intrinsic worth. We have
no right to exploit it by our scientific advances. In fact, I can
realize myself and be a moral being only if I respect nature. The
first Guru of the Sikhs, Guru Nanak said, 14 i.e.
I am a sacrifice to Your creative power which is pervading
everywhere. Your limits cannot be known. A religious person sees God
present in nature, which is infinite. He goes into bliss and realizes
that if this nature is so wonderful, how wonderful its Creator would
be.
Since
the earth is created by God, everything has a right to live, exist
and flourish, we are not within our rights to destroy any species for
neither have we created it nor do we have a right to make it extinct
We may be permitted to use the natural resources but we must remember
that these resources are not merely for the existent generations but
for the future too. So we have an obligation towards these future
generations also. We do not have to merely love and identify with
nature and the existent generations but also the generations to come,
for, they too would be created by God and He would be immanent in
them.
Thus
to conclude, Sikhism stresses on the principle of sanctity of life
which is being questioned by the present day medical practices and
advanced medical technology. As regards genetic engineering, if it is
used for therapeutic purposes it maybe permissible, however genetic
engineering aimed at improving nature, human or enhancement is not
permissible.
Dr.Surjeet
Kaur
Reader
Department of
Philosophy,
University of Pune.
India.
chahal@unipune.ernet.in
Erwin Chargoff, Heraclitean Fire: Sketches from a Life before
Nature, New York, Rockfeller University Press, p.190
8
Michael J Reiss and Roger Straughan, Improving Nature?
The Science and Ethics of Genetic Engineering. 53, Cambridge
University Press, 1996.
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