As the issues and problems facing the field of bioethics expand in audience
and importance, new perspectives and traditions are entering the
conversation. In his book, Buddhism and Bioethics, Damien Keown takes on
the daunting challenge of formulating and introducing a Buddhist voice to
the bioethics discussion. This contribution to the field of "applied
normative ethics" is the first systematic attempt to apply Buddhist
principles to contemporary issues in bioethics. Keown's task is multifold:
posit a set of Buddhist principles by a process of induction from canonical
monastic rules, discern and establish Buddhist concepts and vocabulary
analogous to existing bioethics' rhetoric, and provide substantive
"Buddhist" judgments on particular debates currently raging in the medical
ethics arena. This is no easy cross-cultural and interdisciplinary project.

In setting up his model, which Keown claims is for the general reader, he
provides thumbnail sketches of Buddhism and relevant Buddhist teachings
such as karma, no-self, and rebirth. He then appropriates elements of
Aristotelian ethics and natural law. In particular, he adopts the
Aristotelian position that what it means for humans to flourish involves a
specific goal or telos to be realized through the cultivation of particular
practices. He draws from natural law theory the claim that objectivity in
ethics is possible. Through reflection on basic forms of human good and
ends, one can arrive at objective principles regarding which sorts of acts
are reasonable and which are not. With the particular elements of his
approach defined and his intellectual framework presented, Buddhism, for
Keown, is best understood as a teleological virtue ethic: "In Buddhist
terms, the goal of human perfection is nirvana and this is attained through
the process of moral and intellectual self-transformation, which comes
about through following the Eightfold Path" (p. xii). Keown asserts that
the bases for such integration of Buddhist doctrine with Aristotelian and
natural law precepts are spelled out in detail in his previous book,
entitled The Nature of Buddhist Ethics. Thus he is satisfied with the brief
descriptions of the elements of his model, and the main methodological
focus of Buddhism and Bioethics establishes a set of basic principles with
which to enter the bioethics conversation.

While recognizing the diversity of perspectives within the Buddhist
tradition itself, Keown relies primarily on the canonical and commentarial
literature of the Theravada school. Such allegiance informs his admitted
"fundamentalist" orientation--asserting that problems of scriptural
interpretation can be overcome and moral truth discovered. He claims that
"For Buddhism, scripture is the embodiment of the Buddhas moral insight"
(p. 15) and that it "sees its moral teachings as the expression of
universal principles" (p. 21). Drawing from the five basic precepts of
moral conduct laid down by the Buddha [the prohibitions of the taking of
life, stealing, sexual misconduct, lying, and taking of intoxicants found
in the Vinaya, the monastic code texts of the Pali Canon] and the Buddhist
emphasis on wisdom and compassion, he formulates three Buddhist basic
goods: life, knowledge, and friendship. The cultivation and realization of
these goods constitutes human fulfillment, or enlightenment. From these
basic goods he deduces corresponding principles-given the basic good, it is
always wrong to choose against that basic good. Therefore, his principles
are formulated as follows: it is always wrong to choose against life,
knowledge, and friendship. Equipped with these principles, Keown turns his
focus to the questions confronting bioethics and applies these goods and
this principlist logic to a comprehensive list of contemporary issues, such
as abortion, embryo research, cloning, reproductive technology, euthanasia,
and physician-assisted suicide.

Such a method produces some interesting and challenging conclusions.
Keown's characterization of Buddhism as a teleological virtue ethic is an
accurate and fruitful one, and his presentation of basic Buddhist goods
does hold tremendous potential for future dialogue in bioethics. However,
Keown focuses mainly on life as a basic good, and never really develops the
roles of the other two goods, knowledge and friendship. While the basic
good of life arguably deserves primacy as both a good in itself and the
precondition for the fulfillment of all other goods, knowledge and
friendship remain only cursorily discussed. Furthermore, in his adaptation
of principlist methods, he appears to work only in the realm of absolutes
with no mention of prima facie principles or guidelines for resolving
conflicts among principles.

Keown begins with textually supported discussions of the Buddhist
definitions of biological life and death. But in his application of his
basic good of life, the term life is much broader, perhaps overly so. He
assesses acts in light of the basic good of life with biological
terminology in some cases and with a purely metaphysical approach in
others. The intrinsic value of life as he presents it needs further
explication. This basic good seems to trump all others, a dubious position
for a Buddhist voice. The basic good of knowledge is presented as knowledge
of the Dharma (the teachings of the Buddha), with what appears to be a
quick conflation to a knowledge of right and wrong. Friendship is presented
as the paradigm for interpersonal relations, and more appropriate, Keown
feels, than focusing on compassion. The relationship between knowledge and
compassion is a rich and foundational one in Buddhism, and life itself as a
basic good cannot stand apart from this relationship without failing to be
a Buddhist view.

In the absence of a full exploration into the two goods other than life,
the "virtue" component of Keown's Buddhist ethic is distractingly
underexamined. Moreover, his integration of Aristotelian ethics and natural
law with basic Buddhist concepts becomes suspect. For example, he refers to
the Aristotelian ideal of friendship, which cannot be said to imply the
type of universal friendship he posits as the Buddhist basic good. Another
potential synthesis problem involves Keown's equating Dharma with natural
law. The foundational premise of a conception of Dharma as "the immutable
laws of both the natural and moral orders" invites problems at the very
onset of his project. Many Buddhist scholars would object to such an
understanding of the Dharma. For example, some, especially scholars of the
Mahayana tradition, would claim that the Buddhas teachings are a matter of
upaya, or skillful means, an approach that includes right application of
knowledge and compassion in a situation-specific moral calculus.

Much of the bioethics debate hinges on issues of intention, aim, and
motive-distinctions that Keown rightly addresses. On paper, most of the
relevant bioethics elements are here: definitions of life and death,
distinctions between killing and letting die, motive and aim, and different
ethical orientations such as consequentialism. However, Keown fails to
examine systematically the one natural component of the relationship
between his basic goods--upaya--that informs "virtuous" Buddhist action.
Upaya as "skillful" means is another area where fruitful dialogue between
bioethics and Buddhism lies, and not developing it requires explanation.

Nevertheless, Keown's book is an excellent first step in introducing and
formulating the Buddhist vocabulary and approach necessary for productive
engagement of contemporary issues in bioethics. It succeeds in presenting a
skillfully and creatively crafted Buddhist voice. Keown's applications,
despite some problematic initial claims, are faithful to the Theravada
tradition and offer an invitation to further dialogue with the field of
bioethics.

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by Leslie Rezac
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