Good Deaths: Perspectives on Dying Well and on Medical Assistance in Dying at Thrangu Monastery Canada

Round 1

Reviewer 1 Report

This article consists of six sections. First, the introduction frames the inquiry as one pertaining to the general human question of mortality and the various ways that human beings relate to this aspect of the human condition. The second section introduces Thrangu Monastery Canada (TMC) and its members, making particular note of the preponderance of Chinese people in the membership. The third section describes the research methodology, which included a questionnaire completed by 53 respondents and interviews completed with 15 interviewees. The fourth section describes the Tibetan Buddhist view of death and the concomitant teachings and rituals at TMC related to death. It also included two paragraphs on other beliefs about death expressed by some study participants that appear to be rooted in “sociocultural attitudes” (line 184) rather than Tibetan Buddhist doctrine. It ends with a subsection on a particular ritual pertaining to death that takes place annually at TMC and is scheduled to coincide with the Chinese “ghost month,” which the Author interprets as evidence of “[the Abbot’s] conscious response to the predominant community’s needs” (line 227). The fifth section of the article begins with a description of the recent Canadian legalization of Medical Assistance In Dying (MAID), together with a description of traditional Buddhist attitudes on suicide and killing, which the Author states are both unequivocally prohibited by Buddhist doctrine. It then goes on to describe in four sub-sections the study respondents’ views on MAID (the majority of which are approving) and the Author’s interpretation of those responses as rooted in the principles of non-interference, wisdom and compassion, respectively. The article ends with a brief conclusion that reaffirms the primary finding of the study, that “contrary to what a strict scriptural analysis might suggest, the majority of Thrangu Monastery’s respondents supported MAID at least to some degree or in some circumstances” (lines 494-496).

There are a few issues with this article that, if addressed, will make it publishable.

1)    In the Research Methodology section, the Author states that 53 questionnaires were analyzed. The Author goes on to note that “Two of the fifty-three respondents said they had no religious affiliation, while the other fifty self-identified as Buddhist.” This adds up to only 52 respondents, leaving one respondent’s religious affiliation unremarked upon.

2)    In the section entitled “Good Deaths in Tibetan Buddhism and at Thrangu Monastery Canada,” there are a number of philosophical and textual errors and imprecisions that must be resolved.

a.     Given that this publication venue is not specific to Buddhist studies, certain technical Buddhist terms should be glossed or defined. These include: saṃsāra, the six realms of saṃsāra, merit, Mahāyāna, and sojong vows. They should be spelled according to scholarly standards, which includes the use of diacritics.

b.     When unmodified, the term bardo refers to the intermediate state between death and rebirth. The term Bardo Thödol is the title of a text, most commonly known as the Tibetan Book of the Dead.

c.     Between lines 147-151, the Author obliquely refers to what is known as the Five Aggregates of form, feeling, perception, formation and consciousness, which are the psycho-physical constituents of experience. The author refers to them in shorthand as “physical body” and “the mind or multiple consciousnessnes.” Articulating the latter aggregates as “multiple consciousnesses” is not a scholarly convention that I have ever encountered, and I fear that for the uninitiated reader, this locution may raise a number of unnecessary questions about subjectivity and rebirth.

d.     In the two paragraphs in this section that deal with “differing sociocultural attitudes about dying well,” the Author draws our attention to the views of certain respondents (whose exact number is never cited) who hold views about a good death that seem inconsistent with Buddhist views on the topic. The Author puts a fine point on the Chinese cultural origins of certain of these views, though the Author only cites 4-5 such responses as specifically coming from Chinese respondents, while also admitting that “the notion of a painless and fearless death was not unique to Chinese respondents alone” (lines 188-189). Experiencing a painless and fearless death hardly seems like a value that would be exclusive to Chinese culture. (Indeed it is quite likely that it is shared by many Canadians, at the very least, given the widespread support for MAID.) Without further clarification of the numbers of respondents who hold such views and the proportion of those numbers among Chinese and non-Chinese populations, it is left to the reader to guess whether the Author is suggesting that this departure from Buddhist dogma really is strictly a phenomenon among Chinese sangha members of TMC and, beyond that, whether that view really can be ascribed to Chinese culture specifically. Beyond this, it is unclear what point the Author is making by drawing the reader’s attention to these apparently un-Buddhist views held by Chinese members of the TMC sangha.

e.     It is not clear what the section on the Akshobya Ritual is meant to add to the Author’s analysis.

3)    In the section, “Medical Assistance in Dying,” the Author refers to the Vinaya as “the authoritative source of Buddhist ethics” (lines 270-271), apparently following Damien Keown. (In the introduction, the Author similarly refers to the Vinaya as “the scriptural authority on Buddhist ethics” [line 46]). This claim is a bit partisan, inasmuch as it overstates the primacy of the Vinaya as the Buddhist ethical authority and elides the multiplicity of other sources for Buddhist ethics (including the Jataka tales and especially Mahāyāna teachings on compassion and bodhicitta) that play a major role in Tibetan Buddhism.

On its own, this kind of partisanship is not disqualifying, of course. However, it does end up hemming the author into an unnecessarily narrow definition of Buddhist ethics (and therefore its bioethics) as governed above all by the Pratimokṣa precepts. This then lends itself to reading of the TMC sangha’s views on death as contrary to Buddhist “scripture,” even when there are other scriptural sources out there that are more harmonious with the views that the TMC respondents espouse. In other words, given the fact that there is a plurality of textual authorities on Buddhist ethics, and particularly given the fact that TMC is a Tibetan community (and Keown’s philosophical/scriptural sources are not attuned to all the specificities of Tibetan Buddhism), Keown’s reading seems to have overdetermined the Author’s analysis on this point. The Author does acknowledges that the discrepancy between Keown’s conclusions about the Buddhist view of assisted death and the TMC sangha’s could be traced to the doctrinal differences between mainstream/early Buddhist sources and those rooted in the Mahāyāna and the Vajrayāna. This seems certainly to be the case, which means that the TMC respondents in fact may not have departed drastically from Buddhist ethical views on assisted death; rather, they departed from early Buddhist ethical views on assisted death and actually may have hewed closer to a Tibetan or Mahāyānist view of assisted death. Charles Goodman’s work on Mahāyāna ethics may provide a useful counterpoint to Keown in this regard. All this is to say: once revised, this paper stands to make a wonderful contribution to Buddhist bioethics by specifying some of the distinctive qualities of the Tibetan approach to the topic in contradistinction to early Buddhist approaches.

Author Response

Responses to Reviewer #1

Point 1:

1)    In the Research Methodology section, the Author states that 53 questionnaires were analyzed. The Author goes on to note that “Two of the fifty-three respondents said they had no religious affiliation, while the other fifty self-identified as Buddhist.” This adds up to only 52 respondents, leaving one respondent’s religious affiliation unremarked upon.

Response 1:

Apologies for the confusion. There are 53 respondents. One respondent chose not to identify his/her religion.

Point 2:

a.     Given that this publication venue is not specific to Buddhist studies, certain technical Buddhist terms should be glossed or defined. These include: saṃsāra, the six realms of saṃsāra, merit, Mahāyāna, and sojong vows. They should be spelled according to scholarly standards, which includes the use of diacritics.

Response 2a:

A glossary of terms or detailed descriptions of Buddhist terms can be added in the paper if the guest editor and/or reviewer believe it is necessary. Although the journal is not specific to Buddhist studies, this issue is. I therefore did not include detailed definitions of widely-used Buddhist terms. Secondly, in response to the reviewer’s comment that Buddhist terms “spelled according to scholarly standards, which includes the use of diacritics”, I would reference Harding, Hori, and Soucy’s Flowers on the Rock.  In the “Conventions” section, “Use of Diacritical Mark” (pages vii-viii), it is written:

The editors also found it impossible to maintain a consistent policy on the use of diacritical mars. Scholars use terms from the many Buddhist languages using diacritical marks to indicate their pronunciation, but practicing Buddhists use the same terminology usually without the diacritical marks. Complicating matters, many Buddhist terms have been accepted into the English language where they appear without diacritical marks. Complicating the matter even further, Buddhist organizations which once omitted diacritical marks have begun using them … In this volume, we omit diacritical marks for those Buddhist terms which have entered the English language, as judged by the Concise Oxford English Dictionary (Eleventh edition) … We try to follow whatever convention a Buddhist organization has accepted for itself, whether that includes or does not include diacritical marks.

b.    When unmodified, the term bardo refers to the intermediate state between death and rebirth. The term Bardo Thödol is the title of a text, most commonly known as the Tibetan Book of the Dead

Response 2b:

thodol will be omitted. However, it should be noted that bardo does not simply mean the intermediate state from one’s death to one’s rebirth, as the reviewer notes. As Dzogchen Ponlop Rinpoche explains in Mind Beyond Death, the bardo can be analyzed and segmented into different relative stages (Ponlop Rinpoche explains six bardo stages). As such, in the paper, “the bardo state that one experiences between one’s death and next rebirth” will be used.

 c. Between lines 147-151, the Author obliquely refers to what is known as the Five Aggregates of form, feeling, perception, formation and consciousness, which are the psycho-physical constituents of experience. The author refers to them in shorthand as “physical body” and “the mind or multiple consciousnessnes.” Articulating the latter aggregates as “multiple consciousnesses” is not a scholarly convention that I have ever encountered, and I fear that for the uninitiated reader, this locution may raise a number of unnecessary questions about subjectivity and rebirth.

Response 2c:

I was not referring to the Five Aggregates, and I believe it is unnecessary to explain them for the purposes of this paper. Rather, my use of “multiple consciousnesses” refer to the six or eight consciousnesses that Tibetan Buddhists scholars and teachers use when giving instruction on the mind  (eight is often accepted, but is not universal). It would have been inaccurate to simply talk of the mind and the mind as taking rebirth, hence the use of multiple consciousnesses. To avoid confusion, I will add a footnote after “multiple consciousnesses” that says there are six or eight consciousnesses depending on the Buddhist lineage and scholastic thought that is followed. Furthermore, the sentence will read “death of a physical body does not coincide with the complete cessation of the multiple consciousnesses which are designated as the mind”.

d. In the two paragraphs in this section that deal with “differing sociocultural attitudes about dying well,” the Author draws our attention to the views of certain respondents (whose exact number is never cited) who hold views about a good death that seem inconsistent with Buddhist views on the topic. The Author puts a fine point on the Chinese cultural origins of certain of these views, though the Author only cites 4-5 such responses as specifically coming from Chinese respondents, while also admitting that “the notion of a painless and fearless death was not unique to Chinese respondents alone” (lines 188-189). Experiencing a painless and fearless death hardly seems like a value that would be exclusive to Chinese culture. (Indeed it is quite likely that it is shared by many Canadians, at the very least, given the widespread support for MAID.) Without further clarification of the numbers of respondents who hold such views and the proportion of those numbers among Chinese and non-Chinese populations, it is left to the reader to guess whether the Author is suggesting that this departure from Buddhist dogma really is strictly a phenomenon among Chinese sangha members of TMC and, beyond that, whether that view really can be ascribed to Chinese culture specifically. Beyond this, it is unclear what point the Author is making by drawing the reader’s attention to these apparently un-Buddhist views held by Chinese members of the TMC sangha.

Response 2d:

The sentence in question reads, “Although the notion of a painless and fearless death was not unique to Chinese respondents alone, they were the only ones to suggest dying while sleeping was optimal.” The point here was that a good death was defined as a death while sleeping. This is a departure from theoretical Tibetan Buddhist notions of a good death. Perhaps other people from other cultures also believe death during sleep is the best kind of death. However, in this research, this answer came only from Chinese respondents. And it was clear that only 4 of the 53 respondents defined a good death in this way. It was not stated that the Chinese sangha as a whole held this view. The point this illustrates is that in a religious community of mixed cultural heritage, some of the divergence between religious theory and praxis appears to be a result of socio-cultural heritage. It is unsurprising but must this variable must be considered, especially as this Tibetan Buddhist community is ethnically diverse.

e. It is not clear what the section on the Akshobya Ritual is meant to add to the Author’s analysis.

Response 2e:

The section can be removed. It was originally included to offer an example of a conscientious effort on the part of the Monastery’s Director to meet the needs of his community. One of the foci of this journal issue is how Buddhists adapt their practices to suit local ecological, economic and cultural conditions.

Point 3:

In the section, “Medical Assistance in Dying,” the Author refers to the Vinaya as “the authoritative source of Buddhist ethics” (lines 270-271), apparently following Damien Keown. (In the introduction, the Author similarly refers to the Vinaya as “the scriptural authority on Buddhist ethics” [line 46]). This claim is a bit partisan, inasmuch as it overstates the primacy of the Vinaya as the Buddhist ethical authority and elides the multiplicity of other sources for Buddhist ethics (including the Jataka tales and especially Mahāyāna teachings on compassion and bodhicitta) that play a major role in Tibetan Buddhism.

Response 3:

The reference to partisanship is interesting, given that I acknowledge being a Tibetan Buddhist adherent and that the work of later lineage masters is generally taught at the Monastery. “The Vinaya as the authoritative source of Buddhist ethics” is referenced – this is how the Vinaya is referred to by Keown and Karma Lekshe Tsomo, although I do not believe Karma Lekshe Tsomo suggests (and neither do I) that the Vinaya is the sole authority for ethical behaviour. Perhaps in line 47, it would better read “with the Vinaya, one of the scriptural authorities of ethics for Buddhists worldwide”.

Actually, I believe that many Tibetan Buddhist adherents value the opinions of and the advice from their living teachers more than the Vinaya, However, given that imminent Tibetan Buddhist teachers have been virtually silent on the issue of euthanasia, and Thrangu Rinpoche and the 17^th Karmapa Ogyen Trinley Dorje have also not contributed to the discussion, I cannot offer proof of the above in this paper. I also believe that if either of them were to take a strong position, for or against MAID, a large proportion of their students would follow suit. But this could just be conjecture.

My conclusion was not that this community departs from “Buddhism”, “Buddhist scripture”, or anything of the sort. I reiterate, “Keown’s consideration of the Vinaya and one fifth-century commentator is too limited if examining today’s living Buddhist traditions” (lines 480-481). An improved sentence may be “Keown’s sole consideration of the Vinaya and one fifth-century commentator is too limited if examining today’s living Buddhist traditions”.

Also in the conclusion, I could add the highlighted words to this fragment: “Contrary to what a strict scriptural analysis of the Vinaya might suggest,“ (line 509). But I continue to maintain “For them, maintaining moral absolutes was less important than not interfering with another’s agency, and less important than being able to view each instance of suffering with discerning wisdom and compassion.” (lines 509-513). Discerning wisdom and compassion were explained within a Mahayana Buddhist context in the paper.

I could also add in the conclusion “The source of TMC’s members’ ethical behaviour cannot be traced to the Vinaya or to their Pratimoksha vows alone” if this would be clearer. 

I would hesitate to claim that this Tibetan approach is contradistinctive to early Buddhist approaches; I have not read enough material on early Buddhist approaches. Instead, I would say that the majority of scholarly literature on Buddhist bioethics focused on early texts and Foundational Vehicle communities.

One of the purposes of this paper was to offer anthropological findings of a Tibetan Buddhist community, self-described as adhering to Mahayana principles. The sources of authority of ethical behaviour, for them, are manifold, and is another topic of research that requires a full analysis on its own.  

Author Response File: Author Response.docx

Reviewer 2 Report

Excellent paper with only superficial edits or corrections required. These are as follows based on line and footnote numbers:

78: italicize "puja"

80: missing "at"

90: "the population" of Richmond or British Columbia overall?

134: what is the ratio of respondents to non-respondents who regularly attend the monastery? 53 compares to how many overall? (responds to footnote xliv as well)

135-136: 2 respondents plus other 50 equals 52, not 53

99 and 139: Macau is spelled differently

151 and 164: bardo thodol ("Liberation Upon Hearing in the Bardo") is the name of a text, while the intermediate state is simply called "bardo," so "thodol" needs to be erased

160: move comma to after "bardo" or remove it altogether

153: add "the" before "time of death"

210: italicize "puja"

210: add "a" to "sixty to a hundred"

301: correct "in" to "an"

311: correct sentence wording

318: 52 or 53 respondents?

327-332: seems to be a light grey highlight around the quoted text

349: add "be" before "described"

370: delete "Their bases of"

406: is there a citation for this quote?

489: add "by" before "a multiplicity"

proofread footnote xii

unnecessary space at start of footnote xxviii

Author Response

Thank you for your corrections and comments. All of the edits you suggested will be attended to. Specific responses to some of your queries are listed below:

line 90: in Richmond (this information will be added to the sentence)

line 134: membership, according to the Monastery's email list, was over 400 the last time I checked with office staff, about 3 months ago. Regular attendees, where attendance is >/= 1 week, is approximately 30-40 individuals. This information will be added once verified with the Monastery's secretary.

lines 135-136: Apologies for the confusion. There are 53 respondents. One respondent chose not to identify his/her religion. The sentence will be modified and the information added.

lines 99 and 139: Macau was spelled "Macau" in the original manuscript I submitted, not "Macao". Therefore the spelling will be corrected.

lines 151 & 164: thodol will be erased

line 406: citation is Li Bin Li, which is present in the manuscript. 

Kindly let me know if there is anything else you notice or require.