The Āyurveda and the Four Principles of Medical Ethics

Abstract

This paper examines the ethical frameworks that guide Āyurvedic practices and compares them with those underlying contemporary Western medicine. At the heart of current bioethical debates is the question of whether certain principles can be universally valid across cultures. This paper argues that while the moral vision of Āyurvedic medicine significantly differs from that of Western medicine in various respects, both systems share fundamental ethical principles, notably beneficence and non-maleficence. However, important distinctions arise in their respective conceptions of autonomy and justice, suggesting that these principles may not be as universally applicable as the former two. Drawing on the “four principles” approach of modern Western medical ethics, as outlined in Beauchamp and Childress’s Principles of Biomedical Ethics, this paper challenges the assumption that the principles of autonomy and justice are culturally neutral. Through a comparison with Āyurvedic ethics, we highlight how these principles may not be as universally relevant as commonly assumed, raising important questions about the possibility of a global bioethical framework.

1. Introduction

Āyurveda, the ancient Indian system of medicine whose name means “the science of life” in Sanskrit, has been practiced for thousands of years, offering a holistic approach to health that continues to thrive in South Asia today. This tradition coexists alongside modern allopathic medicine, creating a dynamic landscape where diverse healing philosophies meet. This paper explores the ethical frameworks that underpin Āyurvedic practices and contrast them with those that guide contemporary Western medicine, shedding light on both the profound differences and the intriguing parallels between these two medical paradigms.

Among the numerous scholarly works on the Āyurvedic tradition in India, several address some of the ethical dimensions of Āyurvedic medicine as well. Among the earliest is Julius Jolly (1901)’s contribution to the Grundriss der indo-arischen Philologie und Altertumskunde, later translated into English as Indian Medicine (Jolly 1951). Heinrich Zimmer’s Hindu Medicine (Zimmer 1948) also touches on ethical aspects of the tradition. More focused treatments include Singhal and Gaur’s Surgical Ethics in Āyurveda (Singhal and Gaur 1963), and I. A. Menon and H. F. Haberman’s (Menon and Haberman 1979) article, “The Medical Students’ Oath of Ancient India.” S. K. Ramachandra Rao and S. R. Sudarshan’s multivolume Encyclopedia of Indian Medicine (Ramachandra Rao and Sudarshan 1985–1987) offers further insights. Prakash N. Desai (1989, 1995, 2000) has contributed significantly through his 1989 book Health and Medicine in the Hindu Tradition, his 1995 encyclopedia article on the history of medical ethics in South and Southeast Asia (The Encyclopedia of Bioethics), and his 2000 essay “Medical Ethics in India.” Karin Preisendanz (2007)’s essay “The Initiation of the Medical Student in Early Classical Āyurveda” offers insights on Āyurvedic ethics in the context of the initiation ceremony for medical students.

The most comprehensive treatment of medical ethics in the Āyurvedic tradition to date is the work of Dagmar Benner, later Dagmar Wujastyk. Her 2005 essay, “The Medical Ethics of Professionalized Ayurveda,” (Benner 2005) analyzes the code of ethics titled Practitioners of Indian Medicine (Standards of Professional Conduct, Etiquette, and Code of Ethics) Regulations, 1982, issued by the Central Council for Indian Medicine (CCIM). Benner distinguishes between “Āyurvedic ethics,” referring to the normative values embedded in classical Āyurvedic texts, and “Āyurvedic professional ethics,” which denotes the modern, standardized code developed for contemporary practitioners (Benner 2005, p. 185).

Dagmar Wujastyk’s 2012 monograph Well-Mannered Medicine: Medical Ethics and Etiquette in Classical Ayurveda, offers the most in-depth study to date of ethical thought, pedagogical ideals, and codes of conduct in classical Āyurveda. She draws a key distinction between medical ethics and medical etiquette within the Āyurvedic tradition, defining etiquette as a set of behavioral norms grounded in custom and convention rather than in moral principle (Wujastyk 2012, p. 2). Wujastyk also distinguishes between “Āyurvedic medical ethics,” which pertains specifically to the practice of medicine, and “Āyurvedic ethics,” a broader moral framework governing human conduct more generally (Wujastyk 2012, p. 2).

S. Cromwell Crawford’s Hindu Bioethics for the Twenty-First Century (Crawford 2003) also offers a broad philosophical perspective on the ethical dimensions of Indian medical traditions. Crawford argues that Hindu bioethics is rooted in three basic principles of Hindu philosophy and religion: the transcendent character of human life, the duty to preserve and guard individual and communal health, and the duty to rectify imbalances and to correct states that threaten the life and well-being of humans and non-humans (Crawford 2003, p. 6), principles that are rooted in the notion of dharma.

The current debate in modern bioethics about the possibility or impossibility of delineating a global system of bioethics is centered on the question of whether certain principles can be held to be universally valid across cultures. In her provocative book Against Relativism: Cultural Diversity and the Search for Ethical Universals in Medicine, Ruth Macklin asserts that

[t]o get beyond relativism is not to embrace ethical imperialism. To acknowledge the existence of universal ethical principles is not a commitment to moral absolutism. Ethical principles always require interpretation when they are applied to particular social institutions, such as a health care system or the practice of medicine. In the particulars, there is ample room to tolerate cultural diversity. But our social institutions would still be in the dark ages if we had not progressed to a stage where human rights are recognized and upheld. Once we uphold and promote human rights, we have taken a stand against relativism.”

(Macklin 1999, pp. 273–74).

Others have argued that it is possible to formulate global bioethics that do not imply a single set of moral beliefs of universal validity (Po-Wah 2002, p. 1). In this paper, we will show that while the moral vision of traditional Āyurvedic medicine is naturally different from that of modern Western medicine in many regards, there are principles that are held as so fundamental to both systems that they may be held to be universal: the principles of beneficence and non-maleficence. We will show, however, that there are significant differences in how an individual person is regarded in the two systems and the intriguing nuances in the conceptions of justice.

2. Sources of the Āyurvedic Tradition

The roots of Indian medicine extend over three millennia. References to healing practices are found in Vedic texts, particularly the Atharvaveda, composed around 1000 BCE. This sacred text includes not only spells and charms for healing but also an extensive list of herbal remedies, reflecting a deep connection to the natural world.

One of the key texts in Āyurvedic medicine is the Caraka Saṃhitā, composed between the 3rd century BCE and 1st century CE, and expanded by Dṛḍhabala around 500 CE (see Zimmer 1948, p. 46; Wujastyk 2003, p. 4; 2012, p. 17). This foundational treatise is organized into 120 chapters across eight sections, covering various aspects of health, including body physiology, therapies, and pharmacology. Another important text is the Suśruta Saṃhitā, dated to the 3rd or 4th century CE (Zimmer 1948, p. 45), which is renowned for its detailed account of surgery and surgical techniques.

The Aṣṭāṅgahṛdayasaṃhitā (“The Compendium on the Heart of Medicine”), authored by Vāgbhaṭa in the 7th or 8th century, is considered one of the three great works of Āyurvedic literature, alongside the Caraka Saṃhitā and Suśruta Saṃhitā. Vāgbhaṭa also authored the Aṣṭāṅgasaṃgraha (“The Compendium in Eight Parts”), which contributed significantly to the framework of contemporary Āyurvedic practice (Zimmer 1948, p. 58). Other key figures in the tradition include Mādhava (c. 700 CE), Śārṅgadhara (c. 1300 CE), and Bhāmamiśra (16th century), each offering their own invaluable contributions to the rich tapestry of Indian medicine (Wujastyk 2003, p. xxvi).

The Kāśyapa Saṃhitā, which predates the 9th century, draws heavily from the Caraka Saṃhitā and covers topics such as causes of illness, therapies, and pharmacy. Another noteworthy text is the Bhela Saṃhitā, which survives only in fragments but is believed to date from around 400–750 CE (Mukhopadhyaya [1923] 1982, p. 75). This text is often cited in other medical works, suggesting its importance in the Āyurvedic tradition.

A fascinating discovery in the world of ancient medical texts is the Bower Manuscript, found in a stupa near Kucha, China.1 This 4th–5th century CE collection of Buddhist Hybrid Sanskrit treatises includes the oldest surviving fragments of the Navanītaka, which offers insights into early medicinal knowledge, including the properties of garlic and the preparation of ointments and elixirs. This manuscript provides a unique glimpse into the fusion of Buddhist and Āyurvedic medical traditions.

In the post-classical period, several prominent scholars made significant contributions to the evolution of Āyurvedic thought. Mādhavācārya, a 14th-century scholar, is known for shaping medical practice during his time. Bhāvamiśra, who authored an influential medical encyclopedia in the 16th century, furthered Āyurvedic knowledge. The 17th century saw the rise of Ānandarāyamakhī, a poet and playwright who created Jīvānanda (“Bliss of the Soul”), a dramatic allegory that personifies diseases, offering a unique fusion of medical knowledge and artistic expression. Together, these texts and scholars form a rich legacy that continues to inform Āyurvedic practice and thought today, blending healing wisdom with spiritual and philosophical insights that have endured for millennia.

3. The Influence of the Āyurvedic Tradition Today

The Āyurvedic tradition continues to play a vital role in shaping health and wellness practices across India today. Central to this ancient system is the concept of balance—specifically, the harmonious equilibrium of the three doṣas (humors): vāta, pitta, and kapha. Health, in this view, is a state of balance among these forces, while disease arises from their imbalance. To maintain this balance, Āyurveda recommends diets tailored to an individual’s unique constitution, the seasons, and the surrounding environment. But the medical tradition of the Āyurveda goes beyond the physical body; it connects physical health with mental states, and engages with spiritual concepts of consciousness, self-awareness, and enlightenment.

The use of medicinal plants like turmeric and neem are common in India today, and many people adjust their diets according to the changing seasons and their own body types and personalities—each believed to reflect one’s predominant doṣa. Āyurveda offers a holistic approach to bodily and mental health that reflects an enduring commitment to balanced living.

Āyurvedic medicine is not only a living tradition in India but a formalized discipline taught in universities and integrated into the country’s public healthcare system alongside modern medical practices. Āyurvedic colleges and hospitals are widespread, and the system is recognized by the Indian government.2 This is not to say that there has not been opposition to Āyurvedic medicine in India as well. The Indian Medical Association, a voluntary national organization of physicians in India founded in 1928, has repeatedly questioned the efficacy and safety of Āyurvedic medicine. Most recently, the Indian Medical Association protested when the Medical Council of India (MCI) was replaced by the more Āyurveda-friendly National Medical Commission as an accrediting and monitoring body for medical education and practice in India in 2020. Today, the Ministry of AYUSH is responsible for both allopathic (Western) and traditional medical education and treatment in India (see Desai 2000). AYUSH is both an acronym for “Āyurveda, Yoga and Naturopathy, Unani, Siddha, Sowa Rigpa, and Homeopathy” and a form of the Sanskrit word for “life” that gives name to the Āyurveda itself.3

Beyond India’s borders, Āyurveda’s holistic approach to wellness has garnered global attention. Āyurvedic centers, spas, and wellness retreats have blossomed in countries around the world, offering natural remedies and lifestyle practices. The rising global popularity of yoga and meditation—often intertwined with Āyurvedic principles—has further fueled this worldwide interest, making Āyurveda a cornerstone of a broader movement towards mindful, balanced living.

The Āyurvedic tradition has played a pivotal role in shaping modern environmental consciousness in India. The use of natural herbs, locally sourced ingredients, and eco-friendly practices is integral to Āyurvedic health and wellness. This philosophy aligns with a growing commitment to sustainability, organic farming, conservation, and eco-conscious living.

We argue in this paper that the ethical principles that underpin Āyurvedic medicine offer a compelling contrast to the “four principles” of medical ethics that dominate modern Western medicine. By examining these differences, we will show how Āyurveda’s approach can challenge conventional frameworks, offering valuable insights that could help medical practitioners develop a more inclusive, globally relevant ethic. In an increasingly interconnected world, these alternative perspectives can encourage a richer, more holistic understanding of healthcare that transcends cultural boundaries and fosters deeper compassion and understanding in medical practice.

4. The Four Principles of Medical Ethics: A Western View

Medical ethics is the system of moral principles that guides medical practice, ensuring that care is provided in a way that is both ethical and compassionate. In modern Western medical ethics, the “four principles” approach, introduced in Tom Beauchamp and James Childress’ influential textbook Principles of Biomedical Ethics (Beauchamp and Childress [1979] 2019), has shaped much of contemporary thought. These four principles are as follows: (1) respect for patient autonomy, (2) non-maleficence, (3) beneficence, and (4) justice.

Respect for patient autonomy implies respecting the patients’ rights to make informed decisions about their own treatment, based on full and accurate information. An individual’s autonomy may naturally be limited by factors such as mental incapacitation, but in general, Beauchamp and Childress analyze autonomous action in terms of “normal choosers who act intentionally, with understanding, and without controlling influences that determine their action” (Beauchamp and Childress [1979] 2019, p. 102). Respect for patient autonomy includes principles such as telling the patient the full truth, respecting patient privacy, protecting confidential information, and obtaining consent for any medical interventions (Beauchamp and Childress [1979] 2019, p. 105).

As Wujastyk (2012, p. 124) observes, the principle of respect for autonomy represents a pivotal transformation in the history of the doctor–patient relationship. She contrasts two ethical paradigms: an earlier model of medical paternalism, in which the physician acts according to what he deems to be in the patient’s best interest, without necessarily disclosing relevant information, offering the full or partial truth, or seeking informed consent, and a more recent model that prioritizes patient rights, including the right to full and honest disclosure and the right to make autonomous decisions. The paternalistic stance was largely abandoned in modern medicine in the 1960s (Crawford 2003, p. 1). In the Āyurvedic tradition, as in many older frameworks of medical ethics, the physician is not required to tell the patient the full truth, so long as the intention is to act in the patient’s best interest. The tension between paternalism and autonomy remains a significant ethical challenge in contemporary medicine, particularly in cases where patients refuse life-saving treatments such as blood transfusions for themselves or their children, or in situations involving involuntary psychiatric commitment (see Childress 1981, pp. 17–33 for a detailed discussion).

Non-maleficence implies avoiding any actions that will cause the patient needless harm or suffering. This principle is not just an obligation not to inflict harm, but also an obligation not to impose the risk of harm (Beauchamp and Childress [1979] 2019, p. 159). Both negligence and absence of necessary care are also defined as forms of harm.

Beneficence is acting in the best interest of the patient and contributing to the patient’s welfare (Beauchamp and Childress [1979] 2019, p. 217). But this principle must be weighed against the principle of respect for patient autonomy. In most cases, the kind of paternalism that involves lying to the patient, or refusing to carry out their wishes—even if doing so might benefit the patient—must be avoided. Beauchamp and Childress define paternalism as “the intentional overriding of one person’s preferences or actions by another person, where the person who overrides justifies this action by appeal to the goal of benefiting or of preventing or mitigating harm to the person whose preferences or actions are overridden” (Beauchamp and Childress [1979] 2019, p. 228).

The principle of justice involves a fair and equitable allocation of healthcare resources and treatment and avoiding discrimination in the treatment of patients. But what does this mean in practice? Does the principle of justice imply that all individuals should have equal access to all healthcare, or simply equal access to a decent minimum standard of healthcare? What percentage of available resources should be allocated to prevention versus treatment, or to research versus treatment?

Beauchamp and Childress outline six prominent theories of justice that inform competing models for allocating healthcare resources in society (Beauchamp and Childress [1979] 2019, pp. 271–80):

(1)

Utilitarian theory, which holds that healthcare resources should be distributed in a way that maximizes overall societal utility.

(2)

Libertarian theory, which emphasizes individual liberty and property rights, asserting that equal distribution of healthcare is only justified if all individuals freely consent to it.

(3)

Egalitarian theory, which argues that all members of society should have equal access to adequate—if not maximal—healthcare services.

(4)

Communitarian theory, which prioritizes the good of the community over individual rights, suggesting that health policy should reflect shared societal values.

In addition to these classical theories of justice, they also explore two more recent approaches:

(1)

Capabilities theory, developed by Amartya Sen and Martha Nussbaum, which proposes that justice requires ensuring access to ten core human capabilities: life; bodily health; bodily integrity; senses, imagination, and thought (including education and freedom of expression); emotions; practical reason (the ability to plan one’s life); affiliation; concern for other species; play; and control over one’s environment, including political participation.

(2)

Well-being theory, as articulated by Madison Powers and Ruth Faden, which emphasizes that justice entails securing six essential dimensions of well-being for all individuals: health, personal security, reasoning, respect, attachment, and self-determination.

In this paper, we examine how these four principles now broadly accepted as a basis for modern medical ethics compare with the ethical framework of the Āyurvedic tradition of India. While some scholars, like Gillon (1994, p. 148), argue that these four principles outlined by Beauchamp and Childress are culturally neutral, this paper seeks to challenge that assumption. We will show that two of the “four principles” may not be as universally applicable as they appear, particularly when viewed through the lens of Āyurveda. This comparison offers an opportunity to rethink the foundations of medical ethics in a more globally inclusive context with greater historical depth.

5. “The Four Principles of Medical Ethics” and the Āyurveda

When we compare the “four principles” of medical ethics, as outlined by Beauchamp and Childress, with the ethical guidelines found in the classical texts of the Āyurvedic tradition, we notice some striking parallels. Two of the four principles—beneficence and non-maleficence—are not only foundational to modern Western medicine but also explicitly embedded in the ethical framework of traditional Āyurvedic medicine. This shared focus on promoting well-being and avoiding harm highlights common values across medical systems, offering an intriguing point of connection between contemporary and ancient approaches to healthcare.

1. Beneficence: The principle of acting in the best interest of the patients is the very cornerstone of Āyurvedic medicine. The Caraka Saṃhitā opens with a mythological narrative that underscores the importance of compassion in healing. It tells the story of how medical knowledge was passed down from the Hindu gods to ancient human sages—sages who, the text notes, “put compassion for human beings first” (Caraka Saṃhitā, Sūtrasthāna, 1.5).4 When these teachings were shared with an assembly of wise sages, they responded with awe, exclaiming, “Great is your compassion for all living beings!” (Caraka Saṃhitā, Sūtrasthāna, 1.5). According to the Caraka Saṃhitā, the science of Āyurveda offers wisdom not only for physical health but also for spiritual well-being, teaching humanity “what is good for them in both worlds”—the material and the spiritual realms (Caraka Saṃhitā, Sūtrasthāna, 1.43). This connection between compassion, holistic healing, and the well-being of the whole person is at the core of Āyurvedic ethics, where the patient’s welfare is always prioritized.

The compassion and beneficence of the gods and ancient sages are presented as ideals for human healers to embody. A true doctor, the text advises, should cultivate “friendship for all and compassion for the suffering” (Caraka Saṃhitā, Sūtrasthāna, 9.26). The impact of such care is profound, as the text assures us that “through the gifts of physical relief and long life, the doctor gives righteousness, wealth, and the fulfillment of desires both in this world and the next” (Caraka Saṃhitā, Sūtrasthāna, 16.38). The commitment to healing is so central that a medical student is taught by his teacher to “work for the relief of the patient with all your heart, day and night” (Caraka Saṃhitā, Vimāna Sthāna, 8.13). In this vision, the role of the healer transcends technical expertise and becomes a sacred vocation rooted in selfless care.

2. Non-malefecence: The classical Āyurvedic texts are unequivocal about the importance of non-maleficence—the principle of doing no harm to the patient. In fact, the Caraka Saṃhitā sternly instructs: “You shall not abandon or harm your patient, even for the sake of your own life or your own livelihood” (Caraka Saṃhitā, Vimāna Sthāna, 8.13). This powerful directive highlights the unwavering ethical commitment that a healer must have towards their patient’s well-being, emphasizing that the duty to care may entail personal sacrifice. In this way, the text not only prioritizes physical healing but also stresses the moral integrity that must guide every action of the healer.

3. Autonomy: The principle of respect for patient autonomy is less emphasized in the Āyurvedic texts than in modern Western medical ethics. As noted previously, the shift from medical paternalism to respect for patient autonomy is a recent one in medical history worldwide. Moreover, the relative lack of emphasis on the patient as an autonomous agent may be rooted in the cultural understanding of identity in South Asia. In contrast to the Western notion of the individual as a distinct, autonomous entity, South Asian philosophy traditionally views a person as part of a larger social and religious network. In a landmark essay, anthropologist McKim Marriott introduced the concept of “dividual” identity, suggesting that in South Asia, personal identity is not seen as isolated but as deeply interconnected with the community—whether through kinship, caste, or social bonds (Marriott 1976). This communal understanding of self helps explain the relative lack of focus on individual autonomy in the Āyurvedic tradition.

It is not surprising, then, that the Āyurvedic texts do not place a strong emphasis on an individual’s sole control over their own medical decisions. However, the Caraka Saṃhitā does offer an intriguing insight into the importance of communal consent and the authority of the family unit: it expressly forbids a medical practitioner from entering a patient’s home without being accompanied by a trusted individual who has permission to do so. While this passage does not directly address the autonomy of the patient themselves, it underscores the autonomy of the family and social structure in determining who has access to the household—highlighting a collective rather than an individualistic approach to healthcare decisions. As Hu has noted, a principle of individualism underpins much of Western ethical, political, and social thought. Hu argues instead for a “relational paradigm” in medical ethics that views the individual as part of a larger network of social relations (Hu 2002, pp. 90–92).

4. Justice: In the Āyurvedic tradition, the principle of justice is not addressed in the same explicit terms as it is in Western medical ethics. At first glance, it may seem as if the principle of justice—defined as the fair and equitable allocation of medical resources—is entirely missing from the Āyurvedic texts, which even address in some detail the kinds of patient a doctor should not treat. We argue, however, that ideas of justice are woven into the broader, more comprehensive concept of dharma, a central principle in Hindu philosophy that encompasses moral duty, righteousness, and the ethical obligations one has to society. As we shall see in the next section of this paper, the idea of justice is not a standalone concept but rather part of a larger, interconnected web of responsibilities that guide individual and collective actions. Dharma shapes how medical practitioners approach their duties, ensuring that healthcare is provided in a way that aligns with the greater good, upholds social harmony, and respects the moral fabric of society. Indian medical ethicist Sridevi Seetharam argues that dharma is still highly relevant to current medical practice today (Seetharam 2013). We concur with Seetharam’s assessment and argue that by embedding justice within dharma, Āyurveda invites a more holistic view of ethical practice in current practice as well—one that sees justice as part of a wider commitment to balance, fairness, and ethical responsibility in all aspects of life.

6. The Āyurveda and the Four Goals of Human Life

Āyurvedic medicine is deeply intertwined with the four fundamental goals of human life in Hindu philosophy: dharma (moral duty), artha (prosperity), kāma (pleasure), and mokṣa (spiritual liberation). For an Āyurvedic practitioner, healing goes beyond treating physical symptoms—it requires viewing the patient’s entire life through this broader moral and spiritual lens. Each treatment is not just a response to illness, but part of a larger journey toward harmony and balance across all aspects of life. By considering the patient’s health in relation to these four goals, the practitioner ensures that care is holistic, nurturing not only the body but also the mind, spirit, and moral well-being, guiding the patient toward a more fulfilling, balanced existence. In this way, Āyurveda sees health as a pathway to wholeness—aligning physical healing with the ultimate goals of life itself. As Crawford notes, “health is not the ultimate good but the penultimate good” in Āyurveda, a necessary precondition for mokṣa itself (Crawford 2003, p. 41).

The Caraka Saṃhitā makes a connection between health and the deeper goals of human existence in Sūtrasthāna 1.15: “Good health is the ultimate root of moral duty (dharma,) prosperity (artha), pleasure (kāma), and spiritual liberation (mokṣa).” The text here implies that true well-being encompasses both the body and the spirit.

This holistic view is further underscored in Caraka Saṃhitā’s Sūtrasthāna 11.4-5: “Life is more important than all other things. Why? Because giving up life is giving up everything. Life is maintained by healthy people who observe the rules of wellness and by sick people who carefully alleviate the symptoms of disease.” Here, the Caraka Saṃhitā underscores that the preservation of life—through health—is the gateway to all other meaningful endeavors. Health, in this context, is not merely the absence of disease but an essential force that enables individuals to fulfill their moral, material, and spiritual potential.

Health and wellness are deeply intertwined with the concept of dharma, which encompasses the moral, ethical, and spiritual duties that each person must fulfill according to their unique role in society. Dharma includes living in harmony with the natural and social order, adhering to justice, and acting with integrity. The laws of dharma are not universally applicable; rather, each person has their own particular individual duty (svadharma), based on that person’s role in society, as determined by caste, gender, and stage of life.

In classical Hinduism, a person’s duties are not solely determined by their social class or gender; they are also shaped by the stages of life they pass through. Described in texts like the Dharmasūtras and Dharmaśāstras, the āśramas (stages of life) offer a spiritual blueprint for living a fulfilling and meaningful life. The student (brahmacārya) stage is focused on learning under the guidance of a teacher. In the householder (gṛhastha) stage, a person focuses on marriage, work, and raising children. In the third stage of life, that of the vanaprastha (forest dweller), a person gradually withdraws from worldly affairs and responsibilities to focus more on spiritual pursuits and self-reflection. The final stage of life is that of renunciation (saṃnyāsa), where individuals fully detach themselves from worldly attachments and dedicate themselves entirely to spiritual pursuits and the pursuit of liberation (mokṣa). Saṃnyāsa involves relinquishing all material possessions, social ties, and personal ambitions in favor of a life of meditation, study, and service to humanity. Saṃnyāsa is considered the culmination of the āśrama system, representing the renunciation of ego and preparation for liberation from the cycle of the death and rebirth. While a person’s identity is closely intertwined with caste and gender in Hinduism, the āśrama system provides a framework for molding both one’s moral duties and one’s identity to one’s age and life stage as well. To be a student is to be obligated to study, learn, and maintain a celibate lifestyle, while to be a householder is to be obliged to have a spouse and family.

According to the Caraka Saṃhitā (Vimānasthāna 8.13):

The teacher should say to the student before the sacred fire, Brahmans, and other physicians: “You shall lead a chaste life, grow your hair and beard, speak the truth, refrain from eating meat, eat only pure food, be without of envy, and carry no weapons. You shall do everything I ask you, except hating the king or causing the death of another human being, or comitting a great sin or doing something that leads to disaster.

The call to lead a chaste life refers specifically to the student entering the Brahmacārya stage of life, a period of self-discipline and focused study upon becoming a medical student. This does not imply that all doctors must remain celibate throughout their careers, but rather that it is the dharma of any earnest student to live a celibate life during their studies to cultivate discipline and mental clarity. Similarly, the prohibitions against eating meat and carrying weapons are tied to the purity and moral integrity required during this formative stage. These rules help the student maintain a state of physical and mental purity, laying the foundation for a life dedicated to the well-being of others.

Given the broader moral framework in Hinduism, where ethical living is closely tied to one’s role in society and family, it is no surprise that the Āyurvedic texts frame their ethics around dharma—the unique duties of both medical practitioners and patients—rather than universal principles of justice. The Caraka Saṃhitā provides clear ethical guidelines for both doctors and patients, emphasizing that doctors must act in the best interests of their patients, promote healing, avoid harm, and refrain from unnecessary treatments. Meanwhile, patients are encouraged to take responsibility for their health by maintaining a balanced diet and engaging in regular exercise. However, these duties—whether as a doctor or a patient—are always shaped by one’s svadharma, or station in life. Each individual’s role, defined by their age, social standing, and life stage, dictates how they should fulfill their medical responsibilities, adding a unique layer of moral nuance to the practice of Āyurvedic medicine.

Vimānasthāna 8.13 continues with the teacher’s words to the student:

You shall be dedicated to me and see me as your superior. You shall be ruled by me and conduct yourself with my welfare and pleasure in mind. You shall serve me and live with me like a son or a servant or a devotee. You shall act without pride and with attention, a focused mind, humility, reflection, and obedience. Whether I ask you to or not, you shall strive for your teacher’s purposes alone, as well as you are able.

If you want success, wealth, fame as a doctor, and heaven after death, pray for the well-being of all creatures, beginning with cows and Brahman priests.

Obeying one’s teacher in all matters is another core dharmic imperative during the student stage. The teacher is seen not just as an educator, but as a guiding spiritual and moral authority, whose wisdom shapes the student’s entire path. However, it is important to note that while the student is encouraged to pray for the well-being of all living beings, there is an underlying social hierarchy in the Āyurvedic tradition. In this hierarchy, certain beings, such as cows and Brahmin priests, are revered above others. Cows are considered sacred symbols of non-violence and abundance, while Brahmin priests represent the highest spiritual authority. This hierarchy reflects the deeply interwoven nature of dharma, where one’s duties are not just individual, but are also shaped by broader social and cosmic orders.

Although Āyurvedic texts are acutely conscious of a hierarchical social order, there is still an imperative to help those who are in need of help—with a few exceptions. The Suśruta Saṃhitā states:

You shall help the Brahman priests, your elders, your teachers and friends, the poor, the honest, the chaste, the helpless, those who come to you and those who live nearby, as well as your own relatives, and you shall give them medicine […] But you shall not treat one who hunts or catches birds, a sinner, or someone who leads a degraded life (Chapter 2).5

Although Brahmans and elders are mentioned first, the physician still has a duty of care to those who are poor and helpless. The prohibition against treating patients who hunt animals and trap birds or are degraded sinners are likely tied to ideas of karma; these patients’ illnesses may be assumed to have been caused by their bad karma, and thus beyond the reach of any medicine the physician can offer.

The Caraka Saṃhitā also includes explicit lists of patients whom physicians are advised not to treat. These individuals include not only those who are violent or morally corrupt, but also those who are impoverished, lack attendants, are unwilling to comply with medical instructions, or are suffering from terminal illnesses (Sūtrasthāna 6.3.45; Siddhisthāna 2.4–6; see discussion in [Wujastyk 2012, pp. 56–57]). Patients deemed violent or evil are likely viewed as bearing bad karma. Moreover, the ancient Indian treatise on statecraft, the Arthaśāstra, declares that if a doctor does not report a patient’s strange behavior or suspicious wounds to the authorities and the patient is subsequently convicted of a crime, the doctor will be treated as an accessory and given the same punishment as the criminal (Arthaśāstra 2.35, (Basham 1976, p. 33)), which would make any physician hesitate to treat patients of dubious character. A patient’s poverty or lack of servants, on the other hand, may suggest an inability to receive or follow through with the prescribed treatment regimen. Similarly, those who disregard medical advice—like those with terminal conditions—are seen as cases in which treatment is ultimately doomed to fail.

At first glance, excluding certain groups of patients from a physician’s care presents a profound ethical issue. While these exclusions may make sense within the theoretical framework of a differentiated system of dharma, they will reinforce social inequalities: those who are already poor or marginalized will have less access the care they so desperately need.

Even though the Caraka Saṃhitā advises individual physicians against treating the poor, there is nevertheless evidence that there were some systems in place for providing free healthcare to the poor in ancient India. Fa-hsien, a Chinese traveler visited India in the 5th century CE, reports seeing hospitals funded by private donors in Pāṭaliputra where the poor and sick were treated for free (Basham 1976, p. 35). The Caraka Saṃhitā itself advocates that princes promote medicine “for the sake of protection [of their subjects]” (1.30.29), and the emperor Aśoka famously declared in his second pillar edict that he had established medical care for both humans and animals (Basham 1976, p. 34). In these cases, we see the emergence of a collective dharma: while an individual physician may be absolved of the responsibility to treat every patient, rulers and wealthy patrons bear the duty of providing care for the wider community. Justice, in this context, is not denied but delegated—rooted in a dharmic understanding of societal roles and ethical obligations.

It is particularly striking, then, that the 1982 “Code of Ethics” for modern Ayurvedic practitioners expressly repudiates discrimination based on “religion, nationality, race, party politics or social standing” (Benner 2005, p. 191). This declaration not only reflects the ethical priorities of contemporary pluralistic India but also signals a shift toward a more inclusive vision of medical justice. Interpreted generously, it reconfigures the classical dharmic framework to align more closely with modern human rights discourse, implicitly critiquing the exclusions of the past and inviting a broader, more equitable approach to care.

7. Conclusions

This paper has argued that while the Āyurvedic and Western biomedical traditions are grounded in distinct worldviews, they converge on the twin ethical imperatives of beneficence and non-maleficence. These two principles of doing good and avoiding harm emerge not only as foundational values within each system but as potentially universal touchstones of medical ethics across cultures.

However, the principles of autonomy and justice, as articulated by Beauchamp and Childress, reveal deeper divergences. In the Āyurvedic framework, the individual is embedded within a web of relational duties, defined by age, caste, family, and life stage, rather than understood as an autonomous decision-maker. Ethical decisions are guided not by personal preference alone but by one’s svadharma, the specific duties of one’s social and religious role. Likewise, justice in Āyurveda is not abstract or egalitarian but integrated into the broader logic of dharma, where responsibilities are differentiated, and care is dispensed according to both capacity and merit.

Yet even here, we find surprising resonances with Beauchamp and Childress’ principle of justice. The communal obligation to support the vulnerable, the imperative to protect life, and the evolving commitments of modern Āyurvedic institutions all point toward a flexible, evolving tradition, one that engages meaningfully with contemporary ethical discourse. Rather than framing Āyurveda as an “alternative” to Western bioethics, we might instead see it as a parallel tradition—older, relational, and rooted in cosmological order, yet increasingly attuned to pluralism and human rights.

Ultimately, this comparative study challenges the assumption that Western bioethics offers a neutral or universal framework. It invites us to reimagine medical ethics not as a fixed set of principles, but as a dialog between cultures, histories, and healing systems, in search of a shared moral horizon.