Interview with Bioethicist Deepak Sarma

Dr. Deepak Sarma is the Professor of Indian Religions and Philosophy at CWRU, and is the author of several books on Hinduism and Indian philosophy. After earning a BA in religion from Reed College, Sarma attended the University of Chicago Divinity School, where he received a PhD in the philosophy of religions. His current reflections concern cultural theory, racism, and post-colonialism.

We asked Dr. Sarma a few questions about the current coronavirus pandemic and how he sees it from a bioethical lens.

I taught a class, “Hindu a Jain Bioethics” (RLGN/ ETHS 353), and many of my thoughts on COVID-19 derive from the wonderful conversations I had with those students. I am grateful to them for their reflections and for transforming my way of thinking about Hindu and Jain bioethics. 

How is COVID-19 impacting your current, and potentially future, work as a bioethicist?

COVID-19 has impacted my work as a bioethicist. The current bioethical conversation, even at Case Western Reserve University (CWRU), has embraced what it believes to be a secular and universal bioethics. Religion, by and large—and especially Hinduism—does not play much into these conversations. So Hindu bioethics—which could contribute to these conversions—has been, to some degree, sidelined. In spite of this, Hindu perspectives on disease and cultural distance seem to play an especially important role today, when it is no longer advisable to shake hands with fellow human beings. 

In the Hindu context, I have referred to this as “permissible and forbidden transactions” with special focus on bodily fluids and the maintenance of shuddha (purity). Sound familiar? It should. The worlds envisioned and governed by certain forms of Hinduism are thus centered upon issues of shuddha and ashuddha (impurity). The dharmasastras, a genre of texts about prescribed proper behavior and social interaction, offer a detailed account of how to act in almost every imaginable situation and, simultaneously, to maintain one’s purity. There are rules about when and how to eat; to bathe; to have intercourse; to get married; what sort of woman would be an ideal wife, what sort would not; what sort of job one should have; birthing and funerary practices; even bioethics; and so on. Purity issues are preeminently embodied in the varna (class) and jati (caste) systems, as well as in gender protocols. Purity issues, moreover, are manifested in terms of permissible and forbidden exchanges. Brahmins, who regard themselves at the top of the hierarchy and, therefore, the purest, have to be very careful when it comes to exchanging fluids, or coming into any sort of contact, with those of lower classes. Even accidental contact or fluid exchange incurs adhuddha. Though believing themselves to be naturally pure, Brahmins still have to follow practices that ensure, maintain, and enhance their purity. 

In the dharmashastras, one finds lists of activities that result in ashuddha. These activities largely center around transactions between members of different varnas and jatis, between members of the same jati, and often involve bodily fluids and byproducts. These elaborate lists of restricted items and activities range from restrictions from contact with menstrual blood to the flesh of an animal, from one’s own bodily fluids (“Body oil, semen, blood, marrows, urine, faeces, ear-wax, nails, phlegm, tears, discharge of the eyes, and sweat—these are the twelve impurities of Man,” see The Law Code of Manu, supra note 31: chapter 5, verse 135, at 95), to fluids or foods offered that were touched by another person:

He [a Brahamin] must never eat the following: food touched by a menstruating women, food given by a thief, a musician, a carpenter, a usurer, a man consecrated for a sacrifice, a prisoner, a shackled man, . . . food of a shudra; leftovers, food given by a physician, a hunter . . . food of a women who is impure by reason of childbirth… (see The Law Code of Manu: chapter 4, Verse 207-212)

Some transactions are prohibited. Ironically, the touch of a physician, is explicitly forbidden. There are even texts that warn that the shadow of a lower-class Hindu cast upon an upper-class Hindu causes impurity. 

A great deal of social injustice has been propagated and perpetuated by these forms of Hinduism. I want to alert readers that my presentation of these ideas, some of which are socially unjust, does not mean that I approve or even condone them. Rather, I think that the system offers a structured perspective, that makes it exceptionally useful as a sieve through which to push bioethical issues, and that gives a “slice” of a particular and privileged kind of Hinduism. I do not mean to suggest that the class system ought to be upheld or even transplanted here in the United States (though it is obvious that such hierarchical and socially unjust systems are prevalent). Rather, thinking about the permissibility (or not) of certain kinds of exchanges is central to the issues around the exchange of COVID-19. 

What are your thoughts on the healthcare response to the outbreak in the United States?

The healthcare response to COVID-19 has been the best under the circumstances given that the federal government has delayed and hindered testing and the distribution of personal protective equipment (PPE). The social and economic disparities have become clear in this context too. Privileged people and groups are able to maintain their shuddha-tva (purity) while others cannot. It is unfortunate and devastating that life and death decisions have been made because of limitations on equipment, hospital space, and so on. Many of these complexities and challenges could have been changed or even avoided if a unified healthcare infrastructure was in place already, rather than coddled together at the last minute amidst a crisis. So, while the system has performed as well as can be expected in the circumstances, the circumstances should have been different from the start. 

How do you see COVID-19 changing the way bioethicists study and approach infection-related issues?

Bioethicists will have to take greater consideration into the class divide between the privileged and those who service the privileged in their bioethical reflections.

Can you talk about your background and what drew you to study Hinduism in an academic context?

I had a typical South-Asian-American/Indian-American background. I actually started off doing math and engineering at NYU [New York University] and Cooper Union. I was raised by a very secular scientist; my dad was a (now retired) protein crystallographer, so we watched science programs like NOVA on PBS every night. We very rarely went to the Hindu temple, and my parents certainly did not raise me to think in a religious way or about religion, other than its presence. The narrative I will share with you begins when I was at NYU and Cooper Union. I was rather surprised by how vocational[ly] driven people were around me. Everybody was driven in this vocational way that I did not understand, with their goal of eventually getting a job that could make them enough money to buy a nice car, or something like that. At this time, I was getting exposed to Marxism and critical thinking (now, we might refer to this as cultural theory), which made me suspicious of these sorts of materialist goals; I thought they seemed empty. Why do you need to compete in the first place? Why do you need to have a very fancy car? What is the purpose of all of this anyway? What was the meaning of life?

It seemed to me that the education that people were pursuing at NYU was for nothing more than the pursuit of these empty, materialist goals.These pursuits did not have any good (or obivious) foundations. In this math class that I was taking at NYU, I asked the teacher, who happened to be a grad student, “Why is one plus one equal to two? Teach me some cool philosophical stuff about the basis of mathematical thinking.” He told me, “You do not need to know any of that. You are just going to be an engineer.” I thought, Aren’t I supposed to be getting an education? This person tells me that I did not need to know something because I was just going to be an engineer! The answer he gave me was terrible. Had this TA said, “It seems you are interested in foundational and philosophical questions,” then maybe I would have gotten some good questions and answers. But he told me this anyway, “You are just going to be an engineer.” This was disappointing and led me to think even more about the broader existential questions that I was asking, like Why are we doing this at all? So this led me away from my double major math/ engineering program. As for my interest in Hinduism, I remember looking around and seeing people and musicians that I respected who seemed to find India and Hinduism interesting But in fact, I did not.

I thought, particularly as an Indian-American, It is a peculiar thing to try to assimilate. Part of the assimilation process, at least at that time, was rejecting Hinduism and India. With such a small group of Indians in America at that time, we were isolated—now, if you lived in Edison, New Jersey, you could not reject it even if you wanted to. I remember looking around and seeing people who liked Hinduism and Hindu images. I thought, What is going on here? They like it, I think that they are cool. What is happening here? Is India and Indian things cool? This led me to take a very interesting class at NYU on Hinduism. I was getting questions answered and questions raised that were nothing like the questions I was raising in my engineering classes. Around this time, I found NYU much too vocationally driven for me to continue studying there, so I ended up transferring to Reed College in Portland, Oregon; that was, at the time, the most transformative moment of my life. 

There I ended up taking a Hinduism class with Professor Edwin Gerow, and I found the kind of questions he was asking to be very interesting indeed. He started asking me questions about my background and was able to figure out the religious and philosophical beliefs of my ancestors, namely the thirteenth century tradition known as Madhva Vedanta. It turns out that Professor Gerow was an expert in Madhva Vedanta! Not only was he an expert in this tradition, he was one of two in the western academic world (at that time), had gone to the town of Udupi in south India to read Sanskrit with experts in this tradition, and studied with Sri Bannanjee Govindacarya, who was a distant relative of mine! His connection in Udupi, moreover, who helped him find a place to stay and assist him, was my Dad’s high school social studies teacher!  Gerow was as surprised as I was by this fortuitous connection. At this time, I was thinking a great deal about a simple philosophical question, Do things exist independently of our mind? He knew that I was interested in and driven by this and related questions. This philosophical question I had, it turns out, was one that was asked by the aforementioned Madhva School of Vedanta. This school posited realism, that things existed independently of the mind, which opposed a seventh-century school of idealism, called Advaita Vedanta. He told me, “Deepak, you should study the debate between these two traditions. You will not only satisfy this existential question that you have about whether or not these things exist outside your mind, but you will also get to study your own tradition in the process.” He was absolutely right.

The summer after my junior year, in preparation for my senior thesis (somewhat similar to our own Capstone program), I went to India and studied with Sri Bannanjee Govindacarya. I wrote my BA [Bachelor of Arts] thesis on the Madhva School of Vedanta and looked at this very question about whether or not these things existed independently of the mind. Even after graduating from Reed College, I was still driven by these questions and wanted to learn more. The next step was graduate school, not because I wanted a PhD, not because I wanted to be a professor, but because I was driven to further my knowledge in this area. In fact really never thought that I would become a professor; I just thought I would live a “life of the mind.” I ended up at the Divinity School at the University of Chicago and wrote my dissertation on the school of Madhva Vedanta. In a funny way, it was thanks to that grad student at NYU who said, “You do not need to know this; you’re just going to be an engineer,” that I ended up as a professor. 

How did you become interested in Hindu bioethics?

With Hindu bioethics in particular, coming to Case [Western Reserve], as a vocationally driven school with pre-med students, I thought, How can I connect with my students? The students here are driven to go to medical school, so what could I offer in my class that could be relevant to medical students? At the same time, I met my soon-to-be wife here who is a doctor at the Cleveland Clinic. She spoke to me all the time about medical things and, I, of course, looked at them through the lens of Indian philosophy. So, it is my students and conversations with my wife that led me to apply my knowledge to this field of bioethics. What I discovered is that there are very few books on Hindu and Jain bioethics. The books that are out there are limited to particular traditions of Hinduism but portray themselves as if they are comprehensive and represent all Hindu thought. Imagine if you had a Jehovah’s Witness who wrote a book on Christian bioethics from a Jehovah’s Witness perspective. You would say, “Ok, this is a book on Christian bioethics but it does not speak for all Christians.” It’s like this with most of the publication about Hindu bioethics. I also found that there were and are health care workers who have written about Hindu bioethics, or who were asked to speak about Hindu bioethics, yet did not have enough knowledge about Hinduism to give good and credible answers. In this way, I recognized that Hindu bioethics is a space where much work needed to be done. 

Soon after I was hired to teach at Case, the Hospice of the Western Reserve asked me to give a talk about Hinduism to their healthcare providers. That was the first time I had to really think on my feet about what a Hindu’s response to a half dozen bioethically-related things would be. Hospice care is really about the palliation of a terminally-ill patient’s pain and symptoms, as well as attending to their emotional and “spiritual” needs at the end their life. The Hospice of the Western Reserve was anticipating that they might have Hindu patients, so they wanted to become culturally competent in Hinduism so that they could serve those patients better. Questions that they asked were “How do Hindus interpret pain?” and, “Do Hindus take medication to alleviate that pain?” They were also wondering, if you added the idea of karma to the mix, “Is there a relationship between their karma and their pain?” Some great questions came out of these conversations with the caregivers of the Hospice of the Western Reserve. Their invitation and subsequent questions initiated some of my interest in Hindu Bioethics. 

Thus, I began thinking and talking about Hindu hospice care which overlapped with bioethics, Hinduism, ideas about medicine, and Hinduism in medical care. I suddenly found myself being asked to speak about Hindu bioethics in academic contexts and sometimes even to speak on behalf of Hinduism. That is when it all began, in an academic sense. Really, the academic bioethics world is never strictly academic because, even here at Case [Western Reserve], the academic world overlaps with the clinical world: you have bioethicists that are actually on call in the hospital. I am not, and I do not claim to be, a clinical bioethicist, but I am sometimes consulted by them. A lot of what I am doing these days is responding to concerns, questions, and queries from real-time bioethicists who, like the hospice care workers, want to know what to do in particular situations. There is not much literature that addresses this overlap between academia and the clinical world for bioethicists. The literature that is out there is also so academically driven that your average bioethicist is not going to read it. When push comes to shove, it is technical and written for another academic who specializes in Hinduism; it can be good stuff to read but it is not practical stuff. 

From my conversations with bioethicists, I have learned how to communicate to them the information they need when they are presented with Hindu patients. When a Hindu patient goes to the emergency room and there is some crisis, the bioethicist will know how to think on their feet and use the algorithm that I teach to determine what the Hindu bioethical response ought to be. At the very least, if the Hindu patient is conscious, or their family is conscious, the bioethicist understands their concerns.

The case that was the most intriguing and interesting was one that I worked on in 2013 about a two day-old Hindu Indian boy who was accidentally circumcised without parental consent. The parents did not give consent and the hospital admitted malpractice. The question that arose when the parents made a case against the hospital was whether or not the damages were consequential or trivial. So let’s say you went to the hospital, underwent some kind of surgical procedure, and now have a scar on your buttocks that is not visible. The surgery caused some damage but its trivial because it doesn’t have a significant effect on you. You can imagine the alternative scenario where the damage is consequential. Let’s say they operate on the wrong part of your body, say your arm. So, back to the circumcision case, the family took the hospital to court and the hospital admitted malpractice. The hospital argued it was trivial, but the family argued it was consequential. The question that I was asked to address is, “How does the circumcision of a Hindu boy result in consequential damages, rather than trivial damages?” The question becomes, “What is the nature of the Hindu person, and what sorts of injuries are more consequential than others?” I argued that circumcision is a consequential damage because of some of the texts that I knew concerning purity, impurity, and the excessive contact of outsiders with Hindus, especially when that contact cannot be altered. That’s why those scenarios meant that the court had to award consequential damages. Thanks to the texts that I used and arguments that I made (*snap*), consequential. The broad bioethical question is, “What do Hindus think of circumcision?” I, of course, argued that Hindus don’t do it, and if it’s done accidentally, then it has a significant impact. I’ve worked on a few cases like this one. They have brought my work to the attention of bioethicists and have prompted me to continue this line of work. By the way, 70% of men in America are circumcised whereas only in Muslim countries or Israel do you find such a huge number. If the case went to trial and it was a jury trial, 70% of the people there are likely supportive of it. If there is a man in the courtroom, then there is a good chance that he is circumcised. 

Are they more likely to be supportive of it? Because they did not really have a choice in the matter

I argued that it is a mutilation and is not acceptable in the Hindu perspective. This will not sit well with most members of the jury. When I say that circumcision is not normal for Hindus, you see how that would go, yes? For women who are present, it is likely their male children, if they have any, have been circumcised. Luckily, my arguments were so strong that the opposing counsel realized that the case should be settled out of court. They thought that, if it had gone to the jury, the parents would still win the case because of my testimony. It’s an interesting issue. It makes you wonder, “Am I normal? Am I abnormal? What is normal?” One of the arguments the hospital was making was this interesting data about how, in one particular study in Africa, it was found that circumcision prevented AIDS. You have all kinds of complexities here because of the Judeo-Christian context. It’s really messy, but it was a lot of fun. 

Some of the folks out there doing bioethics are just talking about ivory tower things that your average bioethicist is not going to read or care about. I feel like I am doing something that is useful to people who want to be able to respond and do not know how because they do not have the basic knowledge. Like so many students here at Case [Western Reserve], the bioethicists or doctors who are STEM-oriented probably do not take classes in Hinduism or religious studies because they want to get into med school. They are worried about, What grade am I going to get? Am I going to have to write a paper?, and suddenly, when they are on their feet in the hospital, they realize, Damn! I do not know anything about Hinduism. I wish I would have taken that class with Professor Sarma. To be able to help these practitioners implement their bioethical knowledge and mix it with Hinduism for these different scenarios is a new skill that I have had to develop. 

When it comes down to it, a lot of what I’m doing is a version of Hindu theology. If you think about Catholic bioethics for example, is abortion permissible? When you ask a Catholic, Catholic theologian, or scholar of Catholicism, they are going to look at some religious texts, some Catholic doctrine, see what they say about it, and base their response on those texts. That is what I do, too. When you think about research you think, Am I going to discover something? It is not necessarily the case that I can read a text and discover what Hindus say about abortion, because there are lots of texts out there. They address violence against the fetus, and they address ethical issues about the importance of the mother’s life as well as the fetus’. I have to look at those texts, push the data through those texts, and look at how it comes out. This is a kind of theological activity because I am speaking on behalf of the texts by using the texts. While I am reluctant to say that, because I am not a Hindu theologian, my work is no different than that of a Hindu theologian.

Back in 2007, I made a video about Hindu bioethics through Case [Western Reserve]. The teacher I interviewed was a pundit—a traditionally trained teacher. I asked him, “What do you think of abortion? What do you think of euthanasia?” He thought about the texts that he knew, the narratives that were there, stories and broad rules about purity and impurity, about good death and bad death, and he told me, “Well, because of this text and this passage, and those texts and this story, this is what the outcome should be.” And I do the same sort of thing now. 

You can see from my Huffington Post pieces that I am giving short, pithy statements about what Hindus think, but I want my readers to be able to do this too. Just like the bioethicists that I said ought to learn enough about Hinduism so that they know what is a good Hindu bioethical response, I want Hindus to go and do that too! Many Hindus are not familiar with the texts and they do not take my classes. It is not research in the way that I researched for my PhD, where I am looking through Sanskrit texts, or like the STEM faculty here where I am doing some experiment. What I am trying to do is provide people with the materials they need, or the algorithms they can use, so that when they come across an ethical situation, they can give what they think is a reasonable Hindu bioethical response. Whether they are secular bioethicists, a Hindu patient, or the family of somebody who is a Hindu patient, [they] should feel confident in their response.

In Spring 2020 I taught a class on Hindu and Jain bioethics. I have taught versions of it in the past, but in 2018 I was on sabbatical to study Hindu bioethics: I gave a talk at Cedars-Sinai Hospital in Los Angeles and I did grand rounds at the Cleveland Clinic on bioethics. I gave a few more talks here and there, seeing if I could generate a book with the purposes I just described. 

The biggest challenge with Hinduism, as I said, is that there are all these varieties of Hinduism and it is dangerous to state the Hindu position because then you are inventing this reified Hinduism that is not there, which is what I accuse others of doing. What I struggled with in the fall of 2018 was, How do I do this and not reify? 

There is a right-wing Hindu political party that has control of India. They put forth the position that there is a unified Hinduism. Included in the unified Hinduism are beliefs that India is inherently Hindu, xenophobic, supports anti-Muslim sentiment, and so on. So the struggle that I have is, How do I write something without confirming or buttressing this political position? When I am teaching this in the spring, I have to be careful that I do not reify and do the same thing that my colleagues I mentioned are doing. It is a significant minefield that I have to negotiate, but I am very excited to do it. This past fall [2019], I gave one or two talks on different Hindu bioethics issues. Giving those talks made me think about creating a reader on Hindu bioethics and maybe just writing a monograph on Hindu bioethics. 

In one of your Huffington Post articles, you talk about xenotransplantation to Hindus. Could you speak on this in a bit more detail?

The elephant-headed deity in Hinduism, Ganesh, has the head of a nonhuman mammal. There have been interviews and a few short articles written by doctors who are Hindu, or identify with Hinduism, where they claim that because there is such a creature like Ganesh, Hinduism endorses xenotransplants. People use that to say, “Yes, yes, xenotransplantation is wonderful,” but looking at the story of Ganesh reveals something different. 

The story of Ganesh is simple. There is a god, Shiva, and a goddess, Parvati. They live up in the Himalayas. Shiva leaves his home and goes out meditating. Parvati is by herself and does not want anybody to bother her so she wonders, Who can I trust to make sure nobody enters my house? There isn’t anybody I can trust. She thinks, Aha! Let me create a small boy from myself. According to the Puranic story, she takes the dirt and oil on her skin to mold together this small boy and give him life. She then says to the boy, “Do not let anybody inside the house.” All kinds of gods, people, and creatures come to the house, and he says, “No, you cannot come in.” Shiva then returns home and tries to get into his house, but the boy says, “You cannot come in.” Shiva thinks, Who are you, and why are not you letting me into my house? Shiva, being Shiva, sends his troops to go and take care of this kid. His troops are called ganas in Sanskrit. These troops come and try to convince this boy to let Shiva pass. They get into this battle with the boy to kill him, but they fail. The few ganas come back and say to Shiva, “We could not do it, see you later.” Shiva then gets another god, Vishnu, to help because he owes him. Through some trickery, they are able to decapitate this boy. Parvati then becomes so enraged that the entire universe starts breaking apart. Shiva is not bothered, but the other gods implore Shiva to make up with his wife, so he approaches his wife and says, “I am sorry. What can I do?” She responds, “Give life to this child. Go find the first creature you come across and give life to this boy.” There is no explanation for what happens to the human head here. Shiva comes across an elephant, chops off his head, and uses it to give life to this boy who has no head. The boy is called Ganesh, meaning “Lord of the Ganas”. 

That story is about a father killing his wife’s son, and because his wife is angry, grafting an animal’s head onto the son. That is not endorsing xenotransplantation, unless you say to yourself in the very specific case of a father cutting off the head of his son that you can put a different animal head on it; then we can agree that there is some endorsement. It is funny when you see these Hindu doctors who endorse xenotransplantation because they always cite Ganesh. But after you hear the story, you can say, “Well, that does not really endorse it. This is not a pleasant story where we need to save this kid by giving him a heart valve from a pig. This is a bad story with a peculiar outcome, so it does not endorse xenotransplantation. But why do they think it does?” I try to generate some discussion about it because so many Hindus do not think that deeply about it. It is a chance for me to cause a little bioethical trouble. But it is not necessarily saying that people should not do xenotransplantation.

Are there any powerful examples for or against xenotransplantation elsewhere in the text?

If you take the Ganesh story as is, it is against it, but it is against a particular kind of xenotransplant, which is the head. Let us say the heart valve of a pig is not against that. Could you interpret it that way? I think it is a little weak, largely because there is the death of somebody. It is not somebody who is alive and needs to be kept alive; it is much messier, that is for sure. There is a lot of speculation that is not well-founded in the knowledge of the texts. A lot of people claim to speak for Hindu bioethics who do not know the texts or the slice of texts that address these issues. There are lots of kinds of Hinduism and there is only a small group of texts that are systematic, that some people consider authoritative. 

What are some of the similarities and differences between Hindu bioethics and Jain bioethics?

Jainism began as a rejection of Hinduism. Jains began to reject Hindu practices around the eighth century BC, establishing that the central directive of Jainism is “Ahimsa Paramo Dharmah”—that is, “nonviolence is the highest obligation”. For Jain bioethics, there is no leeway. Any question you ask on whether something is bioethical should be run through the central directive of Jainism, “Ahimsa Paramo Dharmah”. One of the questions you could ask is, “Is abortion permissible?” Of course not. I did a video on Jain bioethics at the same time as the Hindu bioethics. You can see from that conversation with the Jain pundit that there is no variation. I could say, “This woman was raped by her father and this fetus is going to kill her. Is abortion then permissible?” and the Jain would respond, “Nope, because ‘Ahimsa Paramo Dharmah.’” For most bioethical issues, the Jainism philosophy lacks nuance which is really interesting and powerful, in a way; they have this elegance of one position. I used to think of it like when you hit a tennis ball against a wall. The wall is there and no matter where the ball hits, it is going to reflect off of that wall.

In the Hindu world, there are many more loopholes and there is much more flexibility. Abortion, for example, is permissible under certain conditions, such as if the mother’s life is in danger. This is a variation that does not exist in Jainism. The devout Orthodox Jain could never endorse abortion, even when the life of the mother is at risk. If the potential mother dies, she should die. That is her karma. Jainism and Hinduism both embrace this theory of karma: any choice one makes must have a karmic consequence. Jainism and Hinduism can offer ways to have more desirable karmic consequences. It does not mean one can or cannot do something, only that one should know what the karmic consequences are. If you are a Jain, and there is this abortion scenario that I just described, you could have an abortion, but the karmic consequences are massive and negative. Whereas, if you are Hindu, you will have consequences too but they will not be quite as bad. There might also be practices or rituals that you can perform that mitigate those consequences.

Another interesting concept in Hinduism that can be found in Manavadharma Sastra, Manu’s Treatises on Dharmah is “dharma,” or “proper behavior.” There is a section on “apad-dharma,”, which translates to “obligation or duty in a time of crisis.” For example, certain kinds of Hindus should ideally be vegetarians. The question then arises: if there is a famine and the only thing available to eat is dog meat, would an individual eat it? We can say with certainty that Jains would never do that. They would fast until they die. A Hindu, on the other hand, in a time of crisis (as given by a story in a Hindu text) would eat the dog meat. Famine is a time of apad-dharma, a time of crisis. There are some atonements with which one can purify oneself, so you would be permitted to do something like that. Now, thinking about the bioethical world, there is a lot more flexibility. You would have consequences, for sure, but sometimes those consequences can be mitigated in a time of crisis. 

When you think about your own ethics, you might say that you will never do something; but in a time of crisis, this may not be possible. The classic example, an awful one really, is that a man comes into a room and asks, “Where is so and so? I am going to shoot them.” You have an ethic of never lying, but this person is next to you. They will ask you and you will say, “I do not know where they are.” Unless your ethic is to always tell the truth, you will lie, because this is a time of crisis. So, you have these kinds of flexibility in Hinduism that make things a little less strict than in Jainism, where there is little or no flexibility. 

From a medical provider’s perspective, is it accurate to say that Jainism is a lot easier to understand but a lot more difficult to treat? 

Yes. Jainism is so elegant as a theoretical position. Jains restrict their behaviors to create the least amount of violence. An Orthodox Jain, even more so than a non-Orthodox Jain, would not wear leather or eat meat, which seems obvious. In Jainism, there are lists of food items that incur more or less violence. For example, Jains do not eat root vegetables because they may kill an animal or destroy its home in order to get the vegetable. An Orthodox Jain would be exceptionally careful with where they are standing. A monk in Jainism will use a small broom in front of them so that he can brush creatures away and not step on them. Thinking “Ahimsa Paramo Dharmah” means that nonviolence is the highest duty—so what can you do to limit the amount of violence you create? A Jain monk ought to fast motionless until he dies. 

Now, coming back to the contemporary United States, this is an extreme on the continuum of eco-consciousness. Lay Jains, those who are not monks or nuns, practice fasting. A proper Jain will start fasting for one day or for the duration of two meals after becoming seven or eight years old. As a Jain gets older, the fast might last for two or three days, they might vow to only eat two meals every day. This does not mean two big meals because that would go against their principles. They are not “pigging out” so to speak. Some Jains will fast for a month. All they will have is water. I know Jains who have fasted for 37 days. They are practicing because they are not monks or nuns yet, but they are pretty good at it.

Extended fasting has overlapped in interesting ways with euthanasia issues. Imagine you have a patient in hospice care with some fatal diagnosis. That patient decides to slowly restrict food intake. There are some bioethicists who have become familiar with Jainism because of interesting overlaps in these scenarios. Jainism has caught the eyes of bioethicists, not because it is extreme, but rather because the practices in voluntary euthanasia parallel voluntary euthanasia in Jains. This kind of reasoning, justification, and context has been really interesting for non-Jain bioethicists.

How would a doctor go about determining the religious values of a patient who, for example, practices Hinduism?

The doctor or the bioethicist first and foremost should ask and use some probing questions to find out. What a huge error it would be to assume. What if you are talking to somebody who calls themselves Hindu but is really secular? You just have to ask the right questions. Some of these questions are very hard to ask, because you do not want to offend the person; you do not want to presume orientation towards caste and class that they might find offensive. It is another set of minefields that you have to walk through. But bioethicists are pretty good—they are almost like therapists at getting people to say things and trying to figure it out. You can just ask, “Are you Hindu? Do you believe in these things?” That will help you see if you can use the algorithms that you learned and whether you can put the thought in and crank out what the product is. Here is another question that is sort of like that but a little different. 

Is there a place for Hindu or Jain bioethics, or indeed, any bioethics that has a religious foundation in a secular bioethics world?

In the secular world, do Hindu bioethics matter, or indeed, any religious bioethics matter? Is there really a secular world? Bioethicists who claim to be secular have theories about what exists, what does not exist, what is good, and what is not good. Where do they come up with the answers? Are these answers not all humanly constructed as well? If so, then they are no different than a religious position, except that they are secular, [and that] somehow makes them valid. They are likely to have as many agendas and weak foundations as any religion would. 

The most difficult question is, “What is the place of religion in secular bioethics?” Interestingly enough, the medical school has a Department of Bioethics—which I have a secondary appointment in. They do teach a class that involves some religion, but it is all Abrahamic—I think they throw Buddhism in there as well. I have approached them and let them know that I teach Hindu bioethics, but the Department of Bioethics is not as curious as I had hoped. Strangely enough, the Department of Bioethics at Columbia University has an MA [Master of Arts] program, and they asked me to speak to their students about Hindu bioethics. So, you see, there are other bioethics departments that are curious about Hindu bioethics, want a place for Hindu bioethics, or want their students to learn about Hindu bioethics; but Case Western Reserve University is not one of them.

Secular bioethicists and most bioethicists are familiar with Christianity and Judaism and are becoming more familiar with Islam. There is also a familiar kind of colonial embracing of Buddhism. You have a lot of secular bioethicists who know something about Buddhism, and they are cool with it, but nobody knows very much about Hinduism and Jainism. So, when I ask, “What is the place of Hinduism in a secular bioethics world?” I am partly asking, “Is there a place for Hinduism in a Judeo-Christian so-called secular bioethics?” Those are a lot of tough questions that I only ask and poke at.

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