Euthanasia is Bad Karma | Buddhist Analysis of 'Medically Assisted Voluntary Dying' | End of Life Care | Ajahn Dhammasiha
- Ajahn Dhammasiha
- Sep 30
- 29 min read
Do we make Bad Karma if we Participate in Euthanasia, helping to Kill another Person in what's called 'Assisted Voluntary Dying'?
First of all, 'voluntary dying' is a term which in my opinion is used to hide the fact that we are talking about killing of human beings. It's not 'voluntary dying', because it's usually not under our conscious control to die. We can not just opt to die, or wish ourselves to be dead, like we can make ourselves fall asleep. It normally requires considerable effort to end the life of a human being. What's really happening in euthanasia is that human beings are deliberately and intentionally killed. Even if someone requests to be killed, or requests assistance in killing themselves, it's still unwholesome and bad karma if we follow their request and kill them, or assist them in their suicide. The intentional killing of human beings is always unwholesome. The Buddha is unambiguous about the fact that killing is bad karma. Any kind of killing, also animals, is bad karma. The five precepts include to abstain from intentionally killing animals, even mozzies and ants. Once you start intentionally killing human beings, even on their own request, you can create tremendously bad karma.
You may be aware that the Buddha talked about the so-called 'Five Heinous Crimes', the worst kind of things one could do. And two of these five is killing one's mother or one's father. And unfortunately, with euthanasia, people may actually end up participating in the killing of their own parents. This would be really, really serious, really grave bad karma. And people have no idea how much bad karma they're making. Euphemistic expressions like 'voluntary assisted dying' is hiding it from them.
It's interesting you bring up the subject of euthanasia at this time. I was already wondering whether I should be talking about it, because to my knowledge, it is legal now in Queensland. So we have the very unfortunate situation that something which is evil and clearly declared as evil and unwholesome by the Buddha is totally legal. And if it's totally legal, people may come to the conclusion that it's no big problem. But in reality, it is a big problem. They're making very, very bad karma.
I'm not saying that motivation is irrelevant to how much bad karma is being made. For instance, if someone acts on the motivation that they see a person suffering so much that they request to be killed, and they follow that request because they think through euthanasia they can shorten that person's suffering, that's obviously a very different motivation than killing someone against their will to get their money. However, whatever the motivation for the act of killing may be, it's always declared as unwholesome by the Buddha.
If we look at the five precepts, the five training steps in fundamental ethical behavior that the Buddha established, you know the first one is to train ourselves to abstain from the killing of living beings. That includes any kind of killing for whatever motivation. If anyone breaks that first precept, and intentionally and knowingly kills another living being, the motivation will be one factor in determining how much bad karma they're making. For example, if someone is killing in self defense, let's say they and their family get attacked, and they fight back and intentionally kill with the motivation of self defense, that motivation may be considerably less bad karma than murdering someone simply because they hate them so much.
But it is always bad karma to intentionally kill. The Buddha never condoned or encouraged or justified killing of other beings under any circumstance, for whatever motive.
Euthanasia Already Considered 'Normal' for Animals
I'm very concerned about the whole subject, because I'm apprehensive that it will become very similar to the way we're killing animals when they're old or sick. Euthanasia for animals is so well established that people are actually accused of cruelty if they do not put their dog down, or their cat. That's my impression from what I hear, what people are telling me about their pets, and that's a very distorted perception. The distorted perception which is already established in our society, at least with animals, is that it's compassionate to euthanize, and that one really should do it as an act of compassion. And I'm concerned that it will soon become similar for human beings: if you are not supporting or encouraging euthanasia, maybe even for your own parents, the time may come when you're considered cruel and lacking compassion. So it's really important that we understand that correctly.
It's about understanding reality as it is. I'm trying to share what the Buddha has taught us about the realities of death, rebirth and karma. It's not about 'blaming' anyone. I'm not trying to put blame on anyone who's taking their own life. If someone is in so much pain that they want to commit suicide, I really feel for them, they're obviously in a desperate situation. I feel compassion (karuṇā), which means I wish them to be free from pain and misery. I readily admit that I haven't been in that situation, I've never suffered from chronic pain, and I can not know for sure how I would cope myself, how desperate I would feel. However, I do know that according to the Buddha's teaching death doesn't really end suffering. Suicide is not a suitable means for achieving true freedom from pain, it doesn't work. As a Buddhist monk it's my duty to explain that, to the best of my ability, in line with the Buddha's teaching. That's what I'm trying to do, not blaming anyone who's suffering from excruciating chronic pain.
The other reason why I feel it's so important to talk about this subject, is that euthanasia doesn't only involve the dying person. If only the dying person himself was involved, it would be completely their own responsibility, and only they themselves, no one else, would have to face the karmic consequences of their action. But that's not the case. There's the doctors and nurses and pharmacists and psychiatrists/psychologists, and possibly also family members, that are providing or even administering the lethal drugs, or at least they are assisting this whole process. And they all are making very, very serious karma. Compassion has to include all beings, not only the euthanasia patients themselves. I feel compassion also to all those who make bad karma by actively participating in the killing of human beings. Their bad karma can potentially result in suffering much, much worse - and much longer - than what the euthanasia patient is going through! So at least we have to try to inform them how serious the karmic consequences are, according to the Buddha's teaching. Many of them just don't know how bad the karma is they're creating with euthanasia.
Materialistic Worldview Underlies Modern Western Medicine
You see, the root of the problem is that our whole western medicine and the underlying philosophy is basically completely materialistic. Scientific materialism is the worldview that underlies modern western medicine. It's a completely materialistic model that knows nothing else than coarse material phenomena. They explain all bodily functions only by the crude material phenomena, which you can measure via physics, biochemistry, chemistry and so on. And they have no understanding of what we call the mind or consciousness. They have no understanding that a human being doesn't simply vanish and becomes nothing at the moment of death, but that the mind, consciousness, continues beyond death. They have no understanding that at the moment of death, what we call consciousness or mind, is separated from the body and will be reborn, re-connect with a new body, driven by craving and dependent on karma. Instead, they believe that after death there's simply nothing.
Because they're lacking understanding of the nature of consciousness and the rebirth process, they come to completely wrong conclusions. For example, if it was true, hypothetically, that after death there's simply nothing, and you're extremely sick and in great pain, dying quickly could look like an attractive alternative. After all, experiencing nothing may seem preferable to experiencing excruciating pain and suffering.
The problem is that the hypothesis is actually false. It's not true that there's nothing after death. The Buddha teaches us what really happens at death. We're not somehow disappearing into nothingness when we die. Instead, at the moment of death, consciousness disconnects from this body, and driven by craving and dependent on one's karma, connects to a new birth.
That means, first of all, that euthanasia is not actually ending the suffering. That's a big delusion, to think the suffering is gone the moment a cat or dog or human is euthanized. Whether it's a dog or cat or human, it's exactly the same, they're not suddenly dissolving into nothingness when they die. Consciousness will continue. The experience of both pain and pleasure will continue. We just can't see it anymore from outside, we're only seeing the corpse left behind. We usually can't see their consciousness or where it's going, and where it's reborn. So we may come to the wrong conclusion that they experience nothing, just because we can't see their consciousness once it disconnects from their body.
However, if we step back for a moment and reflect, we notice that this view is actually not very logical at all. Things do not come out of nothing and suddenly exist, and then they suddenly become nothing again. This kind of defies common sense. Even regarding material phenomena, that's not how things work. In physics, we have the laws of conservation of energy, and conservation of momentum, for example. Energy and matter are never just vanishing, they are just transformed from one type to another, depending on causes and conditions. It's the same with the mind, the mind doesn't just vanish, but it changes according to causes and conditions; and after death it continues, with karmic causes and conditions determining where exactly it goes.
Therefore, if someone thinks: "I kill this dog because he's got lots of pain, and once I euthanize him, then his suffering is over", this is a delusion. We don't know what suffering the dog has after he has died. We just don't see it anymore. Depending on where his mind goes, the suffering may potentially even be worth. Exactly the same with a human being. If they're reborn in one of the lower spheres of rebirth, the planes of perdition, they potentially could experience even more pain than before death.
The idea that you can free a being from suffering through killing is based on wrong view (micchā-diṭṭhi), the wrong view that after death there's simply nothing (uccheda-vādin). This is a materialist view, which is underlying our modern society, and in particular underlies modern western medical science. I think it's no coincidence that the first patient students usually encounter when they start studying medicine is actually a corpse. That's in the prep course, when they're doing the dissection of corpses right at the beginning of their studies. Medical students are not getting introduced to living patients until quite late in their studies, really working with live patients only in the practical year or internship, or maybe to a limited extend sometime before. But usually, already in the very first semester, they start working with a corpse. To me, that's rather symbolic, that's already a giveaway you're in a very materialistic system. Materialism is the underlying philosophy. Many people may not be consciously aware of that, but nevertheless, philosophical materialism is the foundation on which the whole edifice of modern medicine is built on. And starting with a false premise, they come to an erroneous conclusion: "The moment you kill that being, the suffering is over." No, that's not true.
Once we accept the false premise, we may agree to the wrong conclusion: "Well, yes, experiencing nothing is better than all this terrible suffering." However, the premise is false, in reality this being does not cease to exist. And if that dog, for example, is reborn in hell, the suffering will be much worse than even the suffering when he is dying in this life from cancer. It's the same with a human being. The only thing is that normally you can't see the suffering anymore from the moment that being dies. Very few people have the psychic ability to see how consciousness is established in a new rebirth, or to see a spirit and things like that. So they don't see the suffering anymore.
What euthanasia achieves is only getting rid of having to see the suffering anymore. Are we really motivated by compassion for the dying person? Or is it rather that we want to free ourselves from having to watch and witness the suffering and pain and agony? For the euthanized person, dependent on where their consciousness goes, they may suffer more or less, you just won't know it. But for sure, their suffering is not over. There's only one way to truly end suffering, and that is the full realization of Nirvana. That's the only way to really end suffering.
True Compassion is Not to Kill, But to Provide Good Palliative Care
We can see a beautiful example of true compassion in the Buddha's own reaction when he encountered a very sick monk who was lacking care [Vin Mv 8.26.1-98]. Accompanied by his attendant Venerable Ananda, the Buddha was on a tour to check out the various buildings in the monastery, when he came upon a monk with severe dysentery. That bhikkhu was lying on the floor of his hut, too weak to look after himself, soiled with his own urine and feces, and without any nursing care. The Buddha inquired about his condition, and who's providing nursing care to him. The monk explained that he's suffering from dysentery. He also admitted that he had never done any of his duties to other monks, even when he was healthy, with the result that now no one was providing any help to him.
In response, the Buddha started cleaning up the sick monk personally. Supported by Venerable Ananda, they both carefully bathed his whole body. Then they lifted him up onto a proper bed. Additionally, the Buddha called a meeting of the whole sangha, and urged the monks to look after each other. He even said: "Whoever would attend on me, may they attend on the sick".
This is what you want to do. Not helping people to die, but helping them by looking after them, by supporting them both physically and mentally, providing nursing and care and treatment and pain-management and emotional support.
What patients with an advanced terminal condition need is not an option to be killed, or to kill themselves, but really good palliative care, including pain management. Palliative care means medical care that is not trying anymore to cure the disease, as it's too advanced and terminal. So one spares the patient any unnecessary and possibly very painful and debilitating treatments that can't cure them anymore anyhow. Instead, the care is focussed on keeping the person as comfortable and pain free as possible, and provide the best possible quality of life for whatever time remains for them.
I've discussed that personally with people working in palliative care, nurses and doctors, and one of them actually doing an academic study on this subject, and they all said that it normally doesn't occur that someone wants to be euthanized, if they have really good end-of-life care. In their opinion, a request for euthanasia is usually an indication of shortcomings in the palliative care: they may be lacking state-of-the-art pain treatment, or they feel pressured into another round of chemo, or surgery or invasive procedures, even though they don't have any hope of success anymore. Or they may feel they are a financial or emotional burden for their loved ones.
In their professional experience, if the end-of-life care is really good, and the patient has all the required pain treatment, is assured by family and everyone that they are not a burden, and they have proper health insurance so that they don't struggle financially, and they are not pushed into injurious or futile treatments, then the request for euthanasia doesn't usually come up.
Discontinuing Useless Treatment is NOT a Form of Killing
So we have to distinguish between palliative care and euthanasia. The first Buddhist precept is to abstain from the intentional killing of living beings. However, that doesn't mean that you have to use every medical means available to try to extend the lifespan further. That's two different things. It's one thing to stop ultimately useless or harmful or unbeneficial treatments, and allowing things to run their natural course. And it's a completely different thing to do a treatment which is deliberately meant to kill.
If someone in their nineties is dying from terminal cancer, and they already had 10 rounds of chemo and it just doesn't work, and then they decide that they don't want to take another 11th round of chemo, this is not euthanasia, this is not killing. The first precept against killing does not oblige us to always do all and every possible treatment. It doesn’t mean that we have to prolong the process of dying with all means possible. Deciding against a treatment, or to discontinue a treatment, if it's doing more harm than benefit, is something else entirely than initiating a treatment that aims at causing death. What we can't do is any medication or treatment whith the deliberate aim and function of killing.
I do acknowledge that in real life it can be difficult to define the exact dividing line. For example, a doctor may decide to administer morphine for pain management: morphine is a respiratory suppressor, it reduces the respiratory function, and it can be tricky to decide the exact dosage of morphine. The doctor wants to keep the person pain-free. That means he may want to use a higher dose, as higher doses have a stronger effect against pain. But he doesn't want to go so high that it leads to respiratory failure, and then the person dies from that. So in practice it can be difficult to decide on the exact details of the various treatment options, and it's crucially important to develop very sharp mindfulness about what we're doing there, and what are our true intentions. If the intention is to reduce the patient's pain, and you don't wanna kill them, and then inadvertently the painkiller still ends up being one of the contributing factors for death, this is still not killing, as there was no intention aiming at death. The intention was only to reduce pain. But we have to be really honest with ourselves, we need mindfulness and clear awareness to discern our genuine intentions.
Similarly, it can be difficult to decide how to apply the various forms of life support available in modern medicine. Life support can potentially prolong the process of dying for extended periods, much longer than it would take naturally. Even in the case of failure of vital organs like heart or lungs, life support machines may be able to keep the patient alive, often for quite a long time. Typically, these decisions can't be made anymore by the patients themselves, as they may be unconscious. Families, patients and doctors may have to face very difficult questions, like whether one should attempt resuscitation or not. Or should one use feeding tubes or not, or intubate the patient for artificial ventilation, and when to possibly discontinue life support systems.
In my opinion, it's not possible to resolve these questions in a general manner, one has to look carefully at the exact circumstances of each individual case. However, we do have one dividing line that we should be very careful to never cross: administering a treatment that is actively designed and intended to kill. When it comes to declining or discontinuing a particular treatment option, we have to carefully investigate all details of the individual case to work out the best option for the patient, applying compassion and wisdom and loving kindness in line with Dhamma. But when it comes to using any therapy that is meant to actively kill, that's off-limits, we can't do that if we want to follow the Buddha's teaching.
Obviously, the best is for affected persons to make these decisions themselves. Unfortunately, if they're unconscious one can't ask them anymore what they want. Therefore, the best is to give very clear instructions beforehand what kind of treatment we want or don't want ourselves. That way we can spare our relatives being asked to make these very difficult decisions. In my opinion, it's best to have that formally in writing, even as a legal document. In Queensland it's called, 'Advance Health Directive'. It's a formal form that one can download, and it has to be signed not only by oneself, but by a doctor and a suitable witness. Filling such a form, and thinking it through how to fill it, can be a very beneficial exercise in 'maraṇasati', (contemplation of death); as well as contemplation of impermanence, and reflecting on the true nature of our physical body. These are fundamental Buddhist meditation objects, but it's common that we try to avoid them. Often, we rather don't want to contemplate death and the impermanent, fragile nature of our physical body. Filling such a Health Directive can be a powerful way of directing our mind to actually give some attention to such reflections.
So, good palliative care is the way to go. If they have all the support, pain management and care required, people usually seem to be willing to let the process of dying run its natural course.
Preserving the Taboo against Killing
All religions, to the best of my knowledge, have strong injunctions against killing humans. All societies I know of have strict laws against homicide. And even without any external prohibitions by religion or legal system, we have the faculty of conscience and shame in our own mind ('hiri-ottappa'), telling us that killing of humans is not good, that it's something not to be done. Anyone with a functioning conscience naturally shies away from killing their fellow human beings. Killing humans has long been considered a taboo (at least outside of war, self-defense and criminal justice system), and those who do it are scorned by society.
And it should be a taboo, as it's such grave karma, and has such serious consequences for everyone involved. It's actually not natural for humans to kill other humans. There's strong natural inhibitions against killing. Usually, a person needs very heavy conditioning in order to be able to kill, or their natural inhibitions are overcome by extreme emotions of anger or similar. But normally killing is something very difficult to do. Conscience, shame and natural instinct make us recoil from the act of killing humans. There's a small percentage of persons that are psychopathic, and these few people may find it easier as they lack the normal inhibitions, but for the vast majority of people it's quite difficult to kill.
This is why you'll find that one of the main functions of training in the army is getting people to overcome their natural inhibition against killing other human beings. It's takes a lot of conditioning to make soldiers overcome their conscience and natural instincts in order to do their job of killing. And also to take the risk of being killed themselves, of course. One big problem we have is technology. It starts with having guns. If someone is hundreds of meters away, the inhibition against shooting them is not very strong. If someone had to kill a person by strangling them to death, it would be very difficult to do that, because we have strong instincts and inhibitions against that. However, if someone's just pushing the button for some missile, or if they're just flying in a bomber and dropping some bombs on people they can't see, unfortunately it makes it much, much easier to kill. Therefore, the natural inhibitions we have are less effective in modern warfare.
But normally, we can directly sense that inhibition against killing in our own mind, it's deeply ingrained. In a calm state of mind, not overcome by extreme emotions or propaganda conditioning, killing of a human being is something that most people's mind naturally inclines away from, and doesn't want to do it. There's this strong taboo. And I'm very concerned that with legalizing euthanasia, once that taboo is broken, it's kind of a dam wall breaking. Right now, we are still in a transition period, where most people still feel that taboo strongly. However, with euthanasia now legal, it's gradually becoming more and more normalized, and our inhibition against killing is being weakened.
Killing People is Not an Acceptable Way to Reduce Cost in Healthcare
There's another thing I'm extremely concerned about: to the best of my knowledge, it is apparent that in many countries the current age care and healthcare system is not financially viable in the long term, because we have an aging population and a lot of very cost intensive chronic health issues, and the cost of health care constantly goes up and up. It is quite noticeable that it will be difficult to finance that all.
And at that time of increasing financial pressure in the health care system, now they're making euthanasia legal. And in my opinion, not just making it legal, but almost like advocating and advertising euthanasia. So I'm very concerned that euthanasia is possibly seen as a solution to reduce cost of age-care and healthcare. Obviously, it's much cheaper to have patients euthanized than providing long term care. So I see a great danger that euthanasia is used as a cheap option to save cost.
Just imagine this situation: suppose you have a serious chronic sickness, and it's very expensive to treat. And imagine you're lying there, you're receiving treatment and medication which keeps you in reasonable shape and largely free from pain, but it's expensive. And perhaps you know that your family is struggling to get your treatment financed. The financial resources of the family are under strain, due to your medical condition. But on the other hand, you could also opt for euthanasia, and then that cost is gone. The moment you make euthanasia a viable, legal and accepted option, every sick person is put under pressure, simply by knowing how much money they can 'safe' by having themselves killed. This is not fair. For sure, we have to find suitable means of keeping the cost of healthcare within affordable limits. However, killing the patients is not an acceptable means of saving cost.
So my concern is that over time patients will experience more and more pressure to 'choose' euthanasia. Currently, as they have just introduced it, and there's been quite a bit of controversy around it, they had to include some safeguards and regulations meant to prevent people being pressured into euthanasia. Right now, I believe, there's still consensus that no one should feel coerced into euthanasia. But over time, as killing is getting more normalized, people are getting used to the idea. They experience friends and family, people they know, getting euthanized, and gradually it's getting more acceptable. Before long, the thought may occur: "Why is this one so stubborn, hanging on to their life and resisting being euthanized, when treatment is so expensive? Can't they be more reasonable and free their family from such a burden?"
If fact, this seems to be happening already. Some time ago, the case of a 37 year old woman from Canada was reported in the news:
"Kathrin Mentler went to Vancouver General Hospital in June 2023 seeking treatment after her condition of long-term chronic depression was aggravated by a traumatic event. 'That day my goal was to keep myself safe. I was thinking of maybe trying to get myself admitted to hospital because I was in crisis.'
She said she was told by a clinician that the system was 'broken', and there would be a lengthy wait to see a psychiatrist.
Ms Mentler told the news site she was then asked: 'Have you considered Medical Assistance in Dying?'
She said it was upsetting to be told of another patient who had found 'relief' in death. 'That made me feel like my life was worthless or a problem that could be solved if I chose Medical Assistance in Dying'."
Similarly, the same article mentions how in December 2022, a retired Canadian army colonel and Paralympian testified before a Canadian veterans affairs committee that she was offered 'medical assistance in dying' while fighting to have a wheelchair lift installed in her home:
"Christine Gauthier testified that a veteran affairs case worker had written to her offering to provide a device she could use to take her own life, prompting an apology from Prime Minister Justin Trudeau.
Three other disabled veterans had been offered the same option, according to reports in Canadian media."
These and other reports show how quickly we can end up in a situation where people feel pressured to have themselves euthanized, because it's considered too expensive to properly care for them. And that's a very undesirable and bad situation, it's inhumane.
Inversion of the Meanings of 'Compassion' and 'Cruelty'
So I think that once we have broken that dam wall, and the strong taboo against killing is gone, and everyone gets used to the fact that it's legal to kill humans, the pressure on patients to 'choose' euthanasia will increase. And if your parent is very sick, and is in a lot of pain, and someone suggests it's better to have your mum or dad euthanized, and you oppose that, you may even be accused of being cruel to your parents, which is a complete perversion of the concepts of compassion and cruelty. It's actually an inversion, it's turning these fundamental qualities into their very opposites. It's not compassionate to kill other beings. Instead, it's compassionate not to kill. So we have to be very careful that we are not getting deceived by this value inversion. It's not an act of compassion to kill your parents or anyone. An act of compassion is to provide the best possible care.
I understand that this can be a very challenging subject to talk about, and some people may strongly disagree with me. However, as a bhikkhu (fully ordained Buddhist monk), if you ask me about euthanasia, I really have no other option than presenting the teaching of the Buddha on this subject as accurately as possible. And the teaching of the Buddha is unambiguous on that. There's no exceptions. The Buddha didn't say that we train ourselves to abstain from killing, unless it's 'compassionate', or unless it's happening in a war, or unless it's against terrorists, or unless it's a very old or sick person getting killed, or unless it's only an animal, or unless they actually request to be killed. There's nothing like that. The Buddha said we train ourselves to abstain from killing in all circumstances, it's unconditional, unambiguous, we never intentionally kill if we're truly following the Buddha's teaching.
Therefore, it's so important that we establish good palliative care, instead of euthanasia. Which includes a perspective beyond death. The dying need preparation and guidance for the process of dying, and for the process of rebirth that happens after death. In general, within the modern materialistic worldview, health care workers often feel a bit helpless if they can't cure the patient anymore, and they have no teachings about how to prepare a person, and help them to be ready and to go to the next life in the best possible way. As a consequence, the patient can feel abandoned by the medical system once they're reaching the incurable state. Not necessarily with any bad intention, but simply because the doctors and nurses may have no perspective themselves about the afterlife. If they don't believe in life after death themselves, how could they help a dying patient through that process? So we really need very good palliative care, including both: physical care for the body, and spiritual care for the mind.
I should clarify that I don't mean to force Buddhist views onto anyone. If someone doesn't want any spiritual care, for sure, they should be free not to receive any. Or if they want spiritual care of any religion or philosophy or worldview, they should be free to receive exactly that. But at least they should have comprehensive spiritual care available if they're interested in that, this has to become an integral part of caring for the dying. In the current situation, it is the materialist position of 'there's nothing after death' that is kind of forced onto everyone by default, simply because it underlies the whole medical system.
What we don't need is 'suicide pods'.
They've now designed a high-tech, 3D printed small gas-chamber, that has already been used once in Switzerland, where euthanasia is legal under certain circumstances. However, the use of this machine was considered illegal, and the doctor involved in organizing the suicide with this mobile gas chamber was arrested, and later died by suicide himself at age 47. The design of this little gas chamber is intended to appear very clean and flashy and high-tech, a bit like a space-pod. And they're trying to sell you the idea that death can be easy and clean and painless. Of course, how much pain the person really experiences when they die in there no one knows.
The same gas has been used in the USA for executions, and at the first such execution the convicted "...took more than 20 minutes to die and writhed and convulsed on the gurney." Consequently, the UN Office of Human Rights expressed alarm "...and said that this method may amount to cruel, inhuman or degrading treatment, or even torture."
The little cute looking suicide pod may not be as painless as they promise.
>95% of Suicide Attempts Fail
It is well known that the vast majority of suicide attempts fail, and the person survives the attempt:
USA (CDC, 2022): Approximately 1.4 % of all self‑directed injuries recorded as 'suicide attempts' resulted in death.
EU (Eurostat, 2021): Fatality rates for reported attempts ranged from 0.8 % to 2.3 % across member states, with the highest rates linked to firearm and hanging incidents.
Global Estimates (World Health Organization, 2023): Overall, about 1 %–2 % of suicide attempts end in death, acknowledging substantial regional variation.
Men have fewer attempts then women, but often choose more lethal methods and therefore have higher rates of actually dying from suicide. Woman have more attempts, but fewer of them result in death.[Source: Lumo AI]
There's many people who go through a very tough period in their life, even to the extend that they try to kill themselves. But many of those survive, and later they are o.k. again. In fact, many of the 'attempted suicides' appear to be cries for help, the person doesn't really want to die, they're just trying to show their desperation with some hope of finally getting attention and help. And if they survive, and do get attention and help, they may be perfectly fine later.
I remember one such case personally. A young woman who finished high school the year after me had a previous history of attempted suicide. And for her final exams, it was very tight, she might just pass, or she might fail. Someone asked me if I could pick her up from school right after the exam, as she liked and trusted me, and they were worried that she shouldn't be alone in case she failed. So I did pick her up, and fortunately she had passed the exam, and was quite o.k., and there was nothing much to worry anyhow. And later, she was fine, worked successfully in her job, got married, nothing about wanting to kill herself anymore.
When she attempted suicide earlier as a teenager, she had taken an overdose of sleeping pills. Amazingly, her mother, who was at work, had some intuition, just a hunch, a feeling that she should check on her. So the mother followed her intuition and went home from work to check on her daughter, and found her in time to call the ambulance, who managed to safe her life. But if she had had access to the suicide pod, or if there had been an option to have herself euthanized for mental disorders like depression, she probably would have died.
Danger that Euthanasia will Increase Suicide Rates
That's one huge problem with euthanasia. Many of those 'failed' attempts at suicide will 'succeed', if they are done 'professionally' as a form of euthanasia instead. Once euthanasia is legal and easily accessible, many suicidal people will not try to commit suicide on their own, but they will request euthanasia. And virtually no one survives 'professional' euthanasia, they all die.
I'm aware that in some euthanasia-laws they try to implement safeguards against that. For example here in Queensland, you have to be diagnosed with an incurable condition, that is expected to lead to death within one year, in order to qualify for euthanasia. However, in other countries (e.g. Switzerland, Netherlands, Belgium, Spain and Canada), they have already removed the requirement that the medical condition must lead to death in any particular time frame. Instead, it's enough that the condition causes 'intolerable/unbearable' suffering, and is 'incurable/irreversible'. Some explicitly include non-terminal mental conditions like depression and other psychiatric illnesses.
Now, if someone wants to take their own life, it's obvious that in their own subjective experience they feel that their suffering is 'intolerable/unbearable' - otherwise, they usually wouldn't want to die. And they typically feel that their suffering is 'irreversible/incurable'. Therefore, I'm concerned that euthanasia will become a popular option for anyone feeling suicidal. And that's a huge number of people (according to ChatGPT, in the US one in five adults will experience suicidal ideation at least once in their lifetime).
So many suicide attempts are actually a cry for help. It's a desperate form of expressing: "I need help, please help me, I can't take it anymore!". As mentioned before, more than 95% survive their suicide attempt, with the result that many will finally get some of the help and attention they need, or they may even improve on their own. But once you climb into that suicide-pod, that little mobile gas chamber, and you press the button, you're not going to survive that. Once you're euthanized 'professionally', you're really dead. No second chances there. So we may have many people committing suicide by means of legal euthanasia, because it looks smooth and easy. It is supposedly painless. It's done in a clean, medical environment, with 'doctors' on your side. Very, very tempting for the large number of people who feel suicidal at some crisis point in their life.
If instead we give them good support during the time when they're really down, many of them will recover and be perfectly fine again. Rather than offering them euthanasia, we should be offering them kindness and compassion. We should be offering care and support. That's what the Buddha was always teaching: to have loving kindness (mettā) to all beings, and to have compassion (karuṇā). And that means we wish for them to live long, healthy and happily. We wish for them to be free from suffering. We don't wish for them to die, and we most certainly don't kill them.
Doctors Should not be Killers
Another huge problem, in my opinion, is that they're doing euthanasia within the existing medical system. It's professional health care workers doing it. The people administering euthanasia are doctors. Personally, I'd prefer the profession of executioner and the profession of physician to be separate. If I went to a doctor and I find out he's also working as the executioner, this is not the person I would pick as a doctor, because there seems to be too much of a contradiction for me.
I think this is extremely serious, no one should ever be killed by doctors. You should know when you go to a physician that they're trying to preserve your life. You have to be able to totally trust that they're trying to safe your life, they're trying to preserve your life, they're trying to cure you. And how can we have that faith, if the same people are actually killing humans?
Therefore, additionally to all the other issues mentioned, euthanasia also undermines the ethical foundation of the medical profession. A fundamental principal of healthcare is 'primum non nocere', Latin for: 'First, do no harm'. This maxim is well established in medical ethics worldwide. In the West, it reaches back to the 'Hippocratic Oath' of antiquity. It is also known as 'non-maleficence': before you do anything else, make sure that at least you never intentionally harm anyone. That means, at the very least, I know the doctor will never intentionally harm me. That's number one.
And secondly, the doctor will try to safe my life. Will try to preserve my life. Will try to heal me, get me healthy again. But once the same doctor could now also kill me, how can I trust him? Killing is the ultimate harm. To kill a human being is the most extreme rejection of 'primum non nocere'.
We can find exactly the same principle in the first line of the 'Ovādapāṭimokkha', that famous summary of the teachings of all Buddhas:
Abstain from any evil deed,
accomplish what is good and true,
And fully purify your mind -
That is what all the Buddhas teach.
[Dhammapada Verse #183]
Notice how to abstain from evil is placed right at the beginning, even before the encouragement to do good. And it's exactly the same sequence in the original Pali.
Importance of Right View/Sammā-Diṭṭhi
Instead of euthanasia, we should give the best possible palliative care to people who can't be cured anymore by medical science. And we should give them mental support as well, and spiritual support in particular. We have to get away from this false materialist view that there's nothing after death. A lot of the suffering in the process of dying is not just physical, a lot is mental anguish, fear of what's going to happen at death. If you believe there's nothing after death, that doesn't make it easy to die. It causes a lot of anxiety. Whereas, if you have the perspective that death is not an end point, but that there's rebirth, and that you go on according to your karma, and in particular if you have pure precepts and you have made heaps of good karma, the perspective on death is completely different. You don't die anxiously with fear and doubt in your heart, you die with confidence that you will be fine, that you will go to a good place. You can actually feel that in your heart, and you have the conviction that once you're through the pain of death, you'll be o.k. on the other side.
Giving people that consolation is very important, so that people are informed of the very basic fact that after death there's not nothing. People have to be informed that what is called 'mind' or 'consciousness' actually does continue. That conviction is the number one important thing, because if we start off with wrong view, views that are not in line with reality, then we come to all kinds of wrong conclusions. 'Right view goes ahead', as the Buddha said. If we have Sammā-Diṭṭhi (right view), and we have confidence about survival of consciousness beyond death, we come to conclusions in accordance with reality.
The other thing is the efficacy of karma. We need to know and understand that there are karmic consequences from killing human beings. And that consequence is pain and suffering, and a shortened lifespan. So it's very important to teach people about karma and rebirth, because it opens a completely different perspective. And it's so important to have good palliative care, good pain management. I think this is what most people are much afraid of - pain. But I don't think that if someone is dying, you have to worry anymore that they may become morphine addicts. So we have to do good pain management, if pain is an issue for the dying person.
Suffering is Not Meaningless
The process of bodily decay and dying may appear useless from a materialist perspective. If you think there's nothing after death, then obviously, what's the point of lying there dying, possibly in pain, dependent on care, the body deteriorating more and more, and slowly falling apart. Without any spiritual conviction, without a perspective beyond death, this whole period of decay appears useless, only discomfort and pain. However, from a Dhamma perspective, it is actually an opportunity for contemplation, insight, and letting go. It is possible to have a realization of the Dhamma during the process of dying. We know that because the Buddha himself confirmed such cases. Essential teachings of the Buddha about impermanence, suffering, and not-self naturally become apparent in the process of dying. If the dying person contemplates these three characteristics of anicca, dukkha and anattā, they may be able to gain profound insight, and to let go as a result of their insight, and realize the stages of awakening during the process of dying.
This is so important to keep in mind: if you're dying from a terminal disease, or old age, your life is not useless. In fact, spiritually it can be a more beneficial period than when we're young and healthy and just 'enjoy' life sensually. It can be a period of growth in insight and wisdom, which are qualities more valuable than anything else. And that holds not only for the dying persons themselves, but similar growth can occur in the carers and anyone that comes into contact with the dying person. It wasn't enjoyment of sensual pleasures that caused the Bodhisatta to leave the palace life, and set out on his spiritual quest. It was the sight of an old person, a sick person, and a corpse that caused him to abandon life in the pleasure palace, and to search for the deathless reality beyond suffering, Nibbāna.
In terms of Dhamma, even when you're old and sick and dying, you're not useless, you're not just a burden on other people. This is something that we really have to communicate. A time of pain and bodily decay is not meaningless. It can become of supreme value for ourselves and others, if we use it to contemplate the Buddha's teaching as expressed in the Four Noble Truths:
Suffering: Birth, Old Age, Sickness, Death.
The Cause of Suffering: Craving and Attachment.
The Elimination of the Cause, which is the End of Suffering.
The Procedure leading to the End of Suffering, the Noble Eightfold Path
If we contemplate our pain and suffering as instructed by the Buddha, if we identify craving and attachment as the underlying cause and let go of it through insight, we can free our heart from death, pain and all suffering, and experience the ageless, deathless, pain free state of total freedom - Nibbāna.
This post is based on a spontaneous response to a question about euthanasia by a medical doctor. Due to the serious and controversial subject matter, I have done extensive editing, added some sources relating to the subject matter, and introduced chapter headings. However, to keep it easily accessible, I have tried as far as possible to preserve the original style of a spontaneous Dhamma talk.
Ajahn Dhammasiha, 28/09/2025
