Religious background in medical professionals: Is there an impact on therapy?
The case Buddhadasa Bhikkhu, Thailand

Peter Kaiser MD PhD

Religiöser Hintergrund und medizinische Therapie: Versuch einer Standortbestimmung zwischen Tradition und Moderne am Beispiel des Buddhadasa Bhikkhu, Thailand

Dr. Dr. Peter Kaiser

Abstract
In 1993 a famous monk in Thailand died after weeks of treatment at an ICU, aged 87. Medical treatment against the will of the patient was subsequently discussed in public country-wide. A survey was conduced with Asian and western physicians to get an idea about the opinion of medical professionals on this subject and to illuminate the question: is there an impact of religious or ethical background on decision making in medical therapy? It turned out that medical doctors rather take advantage of the possibilities in modern medical treatment than acting on behalf of the patients interests. Especially in the opinion of buddhist physicians the religious background plays a strong role in their private lifes as well as in their professional decision findings. This can not be confirmed by the data presented. It is concluded, that even though there is a definitely strong influence of Buddhism on daily life, buddhist teachings in urban Thailand are at least at the moment not really able to change treatment towards a more patient-centered medicine.

Zusammenfassung
Im Jahr 1993 starb ein bekannter Abt im Alter von 87 Jahren nach wochenlanger Therapie auf einer Intensivstation. Medizinische Behandlung gegen den Willen des Patienten war anschließend ein landesweites Diskussionsthema. Zur Evaluierung der Einstellung von Ärzten zu dieser Thematik wurde eine Befragung unter asiatischen und westlichen Medizinern durchgeführt, welche insbesondere darüber Auskunft geben sollte, ob religiöser oder ethischer Hintergrund die Entscheidungsfindung in Fragen der medizinischen Therapie zu beeinflußen imstande ist. Es stellte sich heraus, daß Ärzte hauptsächlich von dem medizinisch Machbaren und nicht durch das vom Patienten Gewünschten beeinflußt zu sein scheinen. Insbesondere buddhistische Mediziner äussern die Ansicht, Religion spiele in ihrem privaten wie beruflichen Leben eine bedeutende Rolle. Diese Vorstellung läßt sich durch die Untersuchung nicht bestätigen. Der Autor kommt zu der Aufassung, daß sich in Thailand eindeutig ein starker Einfluß des Buddhismus auf das tägliche Leben nachweisen läßt, buddhistische Lehrmeinungen aber zumindest zum gegenwärtigen Zeitpunkt nicht in der Lage sind, Therapie in Richtung einer eher auf den Patienten hin zentrierte Medizin auszurichten.

Keywords: Thailand, intensiv care, medical ethics, religious background

Schlüsselwörter: Thailand, Intensivtherapie, medizinische Ethik, Religion

Introduction
Thailand is a buddhist country, 80% of the 80 Mio. Thais are ethnic Thai, 15% Thai-Chinese and 4% are Thai-Malay, mainly living in the south. While 93,6% of the thai population claim to be Buddhists, ethnic Thai adhere to Theravada and ethnic Chinese to Mahayana Buddhism. Hindu traders started to come to southern Thailand from the 2nd century AD on. Some became buddhist monks to follow a thai custom that young men when reaching the age of 21 should ordain for one rainy season. The court brahmin e.g. has to become a buddhist monk before he is permitted to act as the advisor to the king and can conduct royal ceremonies.[7] Until today, Buddhism plays a dominant role in rural as well as urban life in Thailand. It is estimated, that there are permanently 300000 monks living in monastries, not counted the short-term stay of nearly all young men, nowadays often reduced to merely 2 weeks.[4] The impact of buddhist thinking, definitely interwoven with a mainly in rural areas still predominant animism, on a lot of sectors of public and private life can not be overlooked. The buddhist clergy frequently makes statements on public subjects, even on politics. Beside other countries in the region, Buddhism remains strong in Thailand, but is in a bit of a crisis due to criticism about sometimes opulent lifestyles of powerful priests and monks as well as accusations dealing with sexual misbehaviour and drug abuse.[1]

Buddhadasa Bhikkhu, born in 1906, ordained as monk in 1926, soon became a figurehead of a reformation movement in thai buddhism, in a time when the transition of the thai society at least at the highest level, the change of the governmental system from absolute to constitutional monarchy took place, in the thirties of this century.[14] Beside others, it was Buddhadasa Bhikkhu who began questioning the heart of Buddhism, forgoing ceremonial frills for the essence- that is of suffering and the eradication of suffering. In his book, ”Handbook of Mankind”, he wrote: ”Buddha points out to us that all things are devoid of any selfenity. They are just perpetual flux of change which is inherently unsatisfactory due to the lack of freedom, the subjection to causality....This unsatisfactoriness will be brought to an end, as soon as the process stops; and the process will stop as soon as the causes are eliminated so that there is no more interaction- this is the heart of buddhism”.[3] He further challenged the ecclesiastical order by studying Buddha´s teachings directly from the ancient Pali Canon (Tripitaka) itself, instead of following the traditional method of studying the interpretational works in the commentaries. Despite frowns from the clergy, he translated the Tripitaka and explained the essence of Buddhism in direct language common people could understand. His thai translations of the pali prayers have now been adopted nationwide. Due to his criticism of the establishment and the media, which he saw as serving materalism and consumerism more that creating favourable conditions to enable man to live in harmony with nature, in the years from 1960 to 1975 he was seen sometimes not only as a ”mad monk” but also as a communist. In the eighties and beginning ninties the reformist monk was hightly respected for being able to combine and balance buddhist learning with meditation practices.
Some years before he died, Buddhadasa Bhikkhu announced in public that in case of fatal illness he don`t want to have any life-prolonging procedures performed on him. ” It was his wish not to have surgery, to pay respect to the laws of Nature by succumbing to death as a part of the natural course of life and to do so at the forest monastery”. [10]
When talking about religion one has all the time to remember that there is a huge difference between the teaching in the books, the sermons by the clergy and the folk believe [13], not only in Thailand but in western countries too. It should be emphazised that the performance of daily work in Thailand very often is accompanied by one or the other form of religious practice.
In this paper it is tried to analyse the impact of religious background i.e. Theravada-Buddhism on decision-making. The investigated group was composed of medical doctors, situated between modern medical knowledge and facilities on the one hand and a system of believe and customs which stresses reincarnation and illusion of body integrity and the uselessness of suffering on the other hand.

Starting point for this article was the behaviour of medical doctors during the therapy of Buddhadasa Bhikkhu at an ICU in a University hospital in Bangkok, discussed very controversially in public and the media: ”many of our doctors who were trained abroad have forgotten their own cultural identity and brought back a new influence of materialism on medicine. This new influence has gathered strength because of its inconsiderate display by all concerned” [6]. Aged 87, Buddhadasa Bhikkhu had a stroke on 27th. of May 1993 in his forest monastery near Surathani, southern Thailand. Without regaining consciousness, he was brougth to Bangkok, Siriraj-University Hospital, by helicopter, subsequently treated at the Intensive Care Unit until the 6th of Juli 1993 at the respirator. Daily medical bulletins on his condition were published countrywide. After the successive failure of several internal organs, Buddhadasa Bhikkhu finally was flown back to his monastery where he expired Thursday July 8th, 1993.

At this time, the author was attending a 6 month course in tropical medicine at the Mahidol University, Bangkok. In the media (in Thai as well as in foreign languages) and in public the dying of Buddhadasa Bhikkhu was frequently discussed. To get some idea about the opinion of medical specialists on this subject, a small survey with colleagues of the course has been carried out.
A questionnaire containing 22 questions was distributed. Beside questions asking sex, country of birth, place where medical education had been achieved, years of working experience, there were 7 more questions on traditional healing in Thailand. 9 of the remaining 11 questions which were dealing with believe, medical intensive care and the fate of Buddhadasa Bhikkhu were selected for the special purpose of this article. After listing the methods, the results of this survey will be presented and discussed in the following chapters.

Methods
A questionnaire containing 22 open and closed questions in English language was distributed by the author to all 54 attendants of the course and recollected after one week. As the language the medical course was taught in has been English, generally no problems with understanding of the questionnaire have been observed. To get some idea about the reception of the questionnaire by the participants, a pilot study with 3 ethnic Thai and 2 western medical doctors was conduced prior to the main survey. No problems of interpretation could be revealed at that time. Due to the small number of participants, a more different statistic analysis was not performed to avoid any statistical overestimation of the results.

Results
45 Medical Doctors (MD) from different countries and therefore with different socio-economical background have been interviewed (i.e. 83% of total 54 MDs), 69% (n=31) male, 31% (n=14) female.

1.Question (Q1):

  • Nationality and religion confession:
  • Answer: see table 1

table 1 distribution of nationality and religion

        Religion      

Nation

buddhism

hinduism

islam

christian

no

religion

total

Thailand

14

 

1

   

15

Burma

8

 

1

   

9

Bangladesh

 

1

 

1

 

2

Vietnam

       

3

3

Laos

5

       

5

Cambodia

1

       

1

Philippines

     

1

 

1

Malaysia

   

1

   

1

Indonesia

   

1

   

1

India

 

1

     

1

Austria

       

1

1

Sweden

     

1

 

1

USA

     

1

 

1

Australia

     

2

1

3

Total

28

2

4

6

5

45

 

2. Question (Q2):

  • ”Do you have working experience at an intensive care unit (ICU)”?:
  • Answer (n=45): Yes: 69% (n=31).

3. Question (Q3):

  • ”Is intensive medical care and treatment necessary”?:
  • Answer (n=45): Strong agree or agree: 96% (n=43); 4% (n=2) were undecided, both of them didn´t have any working experience at an ICU.

4. Question (Q4):

  • ”Should MDs prolong the life of a patient with ICU-techniques, even with a low probability of healthy outcome”?:
  • Answer (n=43): Strongly agree or agree: 74% (n=32), undecided: 14% (n=6), disagree: 11% (n=5), strongly disagree: none. Of the 5 MDs, who quoted with ”disagree”, 4 have had working experience on an ICU, 3 were western foreigners.

5. Question (Q5):

  • ”Prolonging life with ICU-techniques is according to the teachings of the Lord Buddha (or according your religion)”?:
  • Answer (n=45): Undecided 47% (n=21) or no answer 4% (n=2); strongly agree or agree: 20% (n=9), disagree or strongly disagree 29% (n=13).

6. Question (Q6):

  • ”Religion is playing a strong role in your life”?:
  • Answer (n=43): Strongly agree or agree 68% in buddhists (n=19 of 28), 100% in moslems (n=4 of 4), 66% in christians (n=4 of 6). 5 participants replied with "undecided".

7. Question (Q7):

  • ”Your religious background is influencing the way you are making decisions concerning medical problems”?: ·
  • Answer (n=38): Strongly agree and agree 61% in buddhists (n=17 of 28), 75% in moslems (n=3 of 4), 50% in christians (n=3 of 6). 7 participants replied with "undecided".

Correlation Q6 with Q7:
82% of the medical doctors (n=37 of 45), who did strongly agree or agree with the notion, religion is playing a strong role in their life (Q6) did confirm that their religious background is influencing their decision making in the medical field (Q7). The same could be stated in medical doctors without any affiliation to religion: if religion plays not a strong role in ones life, it is not involved in decision making, neither.

Correlation Q5 with Q4, Q5 with Q7:
Caused by the high percentage of MDs who voted in the question ”prolonging life with ICU-techniques is according to the teachings of the Lord Buddha (or according your religion)” (Q5) with ”undecided” or didn`t give any answer at all respectively (together 51%, n=23 of 45), it was senseless to correlate this question with others. If one dares to correlate the remaining possibilities (i.e. strongly agreeing, agreeing, strongly disagreeing and disagreeing) with the question ”should MDs prolong the life of a patient with ICU-techniques, even with a low probability of healthy outcome” (Q4) and the question ”religious background is influencing the way of making decisions concerning medical problems” (Q7) it can be observed, that there seems the trend of confirming the statement in Q5 as well as in Q4 and/or in Q7 and vice versa: disagreeing with the opinion in Q5 is frequently combined with disagreeing in Q4 and/or Q7. No number are shown in this article due to of small case-groups.

Correlation of Q7 with Q4:
The correlation of the question: ”Your religious background is influencing the way you are making decisions concerning medical problems” (Q7) with the question ”should MDs prolong the life of a patient with ICU-techniques, even with a low probability of healthy outcome” (Q4) revealed the following results: 69% (31 of 45) did show a positive correlation, i.e. if the MD is confirming the notion that the religious background is influencing the way of making decisions concerning medical problems, it is more likely that he/she will support life-prolonging procedures at an ICU; and vice versa with nonconfirmers (see above).

8.Question (Q8):

  • ”Do you know the venerable Phra Buddhadasa Bhikkhu”?:
  • Answer: He was well known by the Thai and Burmese MDs, (all buddhists, except one moslem Thai MD) as well as by the group of the western doctors, and unknown by buddhist doctors from Laos, Cambodia, and one doctor from Thailand as well as doctors from all the remaining other countries. In total, Buddhadasa Bhikkhu was known by 60% (n=27 of 45) of the group. (table 2)

table2 distribution of medical doctors knowing Buddhadasa Bhikkhu

 Religion             nation

buddhism

christian

islam

no

religion

knowing Buddha. Bhikkhu

%

Thailand

14

     

13

93%

Thailand

   

1

 

1

100%

Burma

8

     

8

100%

Burma

   

1

 

0

0%

Laos, Cambodia

6

     

0

0%

Austria

     

1

1

100%

Sweden

 

1

   

1

100%

USA

 

1

   

0

0%

Australia

 

2

 

1

3

100%

Total

28

4

2

2

27

60% ²

²computed from n=45

 

This 27 MDs were asked:

  • 9. Question (Q9a,b,c):
  • ”Recalling the dying of the famous monk, who passed away after several weeks of unconsciousness on the ICU after being treated at Siriraj-Hospital in Bangkok and whose will was, not to receive life-prolonging high-technique-medicine, because this would mean more suffering- the MD in charge:
  • 9a - should have let him die earlier?
  • 9b - should have tried harder?
  • 9c - have done the right one has to do in this situation?
    (To each sub-question the participants could reply with strongly agree, agree, undecided, disagree, strongly disagree. In the results strongly agree and agree will be combined to agree, strongly disagree and disagree to disagree.):
  • Answer: It can be shown, that there was a great difference between the replies of the western medical doctors (n=5) and the Thai and Burmese MDs (who did know Buddhadasa Bhikkhu). To sharpen the picture, the only moslem Thai MD was excluded, the remaining 21 Asian MDs were all followers of the Theravada-Buddhism.

Therefore this two groups were compared: Buddhist MDs and western MDs

Ad Question 9a (”let him die earlier”):

  • All westeners i.e. 100% (n=5 of 5) did agree, whereas 65% (n=13 of 20) of the buddhist MDs did disagree.

Ad Question 9b (”should have tried harder”):

  • All westeners i.e. 100% (n=5 of 5) did disagree, whereas 60% (n=12 of 20) of the buddhist MDs did agree and only 15% (n=3 of 20) did disagree.

Ad Question 9c (”have done the right one has to do in this situation”):

  • 80% of the westeners (n=4 of 5) did disagree, whereas no buddhist MD did so. 71% of them (n=15 of 21) did agree with the treatment, 29% (n=6 of 21) replied with ”undecided”.

It can be stated that the questioned westeners, disregarding their religious background (christian or atheism/nihilism), are more reluctant to prolong life at the ICU (Q4 and are unsure about the valuation of such procedures by the religious canon. In the special case of Phra Buddhadasa Bhikkhu, the westeners are definitely more reserved in medical treatment as well as judging the actions of the MDs in charge as correct.
In contrast, the buddhist MDs hold the opinion, that in general, prolonging life at the ICU even with a low probability of healthy outcome is good (Q4) (agree: 81% (n=17 of 21)). In the presented case, the MDs in charge beside having done the right thing, should have tried harder. Even 57% (n=12 of 21) of this buddhist MDs did think that religion is influencing the way they are making decisions concerning medical problems (Q7) (33% did not, (n=7 of 21)), the majority had no idea, to what extend prolonging life at an ICU is according to the teachings of the Lord Buddha (Q5) (undecided: 43% (n=9 of 21)).
Details are listed in table 3

table 3 distribution of answers in the group of MDs who did know Buddhadasa Bhikkhu

Number

specify²

Q 9a

Q 9b

Q 9c

Q 4

Q 5

Q 7

1

Thai, B

undec.

Agree

agree

agree

disagree

disagree

2

Thai, B   

agree

Agree

agree

agree

agree

agree

3

Thai, B

--

--

agree

agree

disagree

disagree

4

Thai, B

disagree

Agree

agree

agree

disagree

disagree

5

Thai, B

undec.

undec.

undec.

undec.

undec.

agree

6

Thai, B

disagree

Disagree

undec.

disagree

undec.

disagree

7

Thai, B

disagree

Agree

undec.

agree

disagree

disagree

8

Thai, B

disagree

Agree

agree

agree

undec.

agree

9

Thai, B

disagree

Agree

agree

agree

disagree

undec.

10

Thai, B

undec.

undec.

undec.

undec.

undec.

disagree

11

Thai, B

disagree

Agree

agree

agree

disagree

agree

12

Thai, B

disagree

Agree

agree

agree

agree

agree

13

Thai, B

disagree

Disagree

undec.

agree

agree

agree

14

Burmese, B

undec.

undec.

agree

undec.

undec.

agree

15

Burmese, B

undec.

undec.

agree

agree

agree

agree

16

Burmese, B

disagree

Agree

agree

agree

undec.

undec.

17

Burmese, B

disagree

Agree

agree

agree

disagree

disagree

18

Burmese, B

undec.

Agree

agree

agree

undec.

agree

19

Burmese, B

disagree

undec.

undec.

agree

undec.

agree

20

Burmese, B

disagree

Agree

agree

agree

agree

agree

21

Burmese, B

disagree

Disagree

agree

agree

undec.

agree

22

West, N

agree

Disagree

disagree

agree

undec.

undec.

23

West, N

agree

Disagree

disagree

disagree

undec.

disagree

24

West, C

agree

Disagree

undec.

disagree

undec.

agree²²

25

West, C

agree

Disagree

disagree

agree

agree

disagree

26

West, C

agree

Disagree

disagree

disagree

undec.

undec.

² legend:
buddhist = B, christian = C, no religion = N
MD from Thailand: Thai; from Burma: Burma; from western countries: West
strong agree or agree: agree; undecided= undec.; strongly disagree or disagree: disagree
no answer: --
²²: MD marked in his questionaire, that religion for him is identical with ethics

 

Discussion
Western medicine was introduced to Thailand by the Prebyterian Mission Board following their arrival in 1828. Early contacts to the Portuguese, French and British during the 16th., 17th. and 18th. century didn´t have a strong impact on the medical system of the country which footed to a large extent in the Ayurvedic and Traditional Chinese Medicine. Main purpose was to lower the high toll of death caused to infectious diseases such as cholera, smallpox and malaria. The first medical school of western medicine was established at Siriraj Hospital in 1889, which remains the most important seat of modern medical education in Thailand today. The majority of medical students are trying to get some medical experience abroad. Participants of the course in tropical medicine, where the survey was performed, all Thai MD´s except two, received at least a part of their medical training abroad.
High-tech western medicine is hold in high esteem by the population as well as by the medical professionals. Traditional Thai Medicine can be found in rural areas and in the informal sector, the efforts to promote the use of this century-old wisdom are more or less half-hearted, but are improving in the last years, especially since it was recognized that traditional medicine is quite cheaper than western medicine.[8] The access to medicine, especially to expensive western medicine e.g. with ICU-facilities is limited to urban centers. The population per physician in the whole country is 4832, in Bangkok metropolis 1165, in other provinces 7618 (numbers for 1988).[9] In Thailand, apart from mentioned localities, people with chronic disease suffer at home, and generally die at home too.

The analysis and evaluation of the survey is definitely restricted caused to the small number of participants. Therefore discussion and conclusion can only represent an approximation.
Attempting to explain the opinion of the interviewed medical doctors, it is advantageous to divide the participants in two groups: MDs from western countries and buddhist physicians. Concerning the confirmation of the statement ”is intensive care and treatment necessary” no difference between the two groups can be observed. I.e. in general disregarding the religious background, ICU-treatment is considered as a useful tool in helping the patients.
But regarding the notion that MDs should prolong the life of a patient with ICU-techniques, even with a low probability of healthy outcome, the differences between the two groups become obvious, described in the group of the physicians knowing Buddhadasa Bhikkhu. The same can be applied to the questions dealing with the medical treatment at the ICU in the case of Buddhadasa Bhikkhu: Westeners are (perhaps) more realistic on the lacking benefit of such procedures and less willing to approve efforts carried too far. In buddhist physicians the believe in the supremacy of high-tech medicine seems unlimited.
It is striking, 68% of the buddhist MDs confirm that religion plays a strong role in their life and 61% of the same group think that their religious background is influencing their decision making in the medical field. Actually the data suggest that there does not exist a closer connection between religious background and medical decision making. This contradiction is partly weakened by the fact that a lot of MDs (both buddhist and western) have no idea to what extent prolonging life (at an ICU) is according to the teachings of their religion. This is rather interesting, as both religions, Theravada-Buddhism as well as the Christian Churches had already taken position to this complex of questions.
Only few of the physicians seem to have some knowledge on this subjects. The correlation therefore, that MDs who do agree with the notion, religion is playing a strong role in their life with the confirmation at the same time that their religious background is influencing their decision making in the medical field, has no significance for their attitude towards medical treatment at all. Perhaps it is only the consciousness which make them stating that they are influenced by their religious background. In fact the medical ”world” as well as the public opinion has the strongest impact on decision making. As everybody working in this field can confirm, it is one thing to talk about ethics and human/inhuman medicine, the other thing is to be in charge at an ICU, where the first object of medical efforts seems to keep the patient alive until one´s shift is over. The pressure of the public opinion especially in the case of Buddhadasa Bhikkhu can´t be underestimated. Paramedics claimed having the capacity to heal the patient, and there would have been an outcry in the media if the MDs at Siriraj-Hospital didn´t have tried so hard, at least in the first weeks of Buddhadasa Bhikkhu suffering. It should not be ignored, that Thailand is still a country struggling to overcome the threshold to the industialised nations. A ”medical failure” at the most famous hospital in the country would demonstrate that this goal is still far ahead. The so important "not loosing ones face" is an explanation. Physicians work today is done in public. The more the media and public opinion is sensitive on the subject of life-prolonging procedures, the more MDs feel they are forced to act and react. As we have seen in the Third Reich, many of the physicians did follow offical guidelines, disregarding ethical standards. Ethic commitees are useless as long they are not able to translate their ideas and resolutions into the language of the common people. New or renewed values have to be integrated in education. Only then, they have the capability to influence decision making. As shown in the paper, western doctors are probably more reluctant to prolong life at an ICU. It will be wrong, making a "higher" ethic value system responsible for that fact. Perhaps it only derives from a greater working expericence at an ICU and a different judgement of this procedures by the public. [5, 11]
While in the West, specialists in medical ethics are working on a binding ethic value system in the medicine of a postconfessionalistic society, Thailand and for sure other countries in the same situation are trying to define themself between their centuries-old traditions and the modern world. [2] In the case of Buddhadasa Bhikkhu, it could be rather simple. Theravada-Buddhism as well as the reformistic teachings of Buddhadasa Bhikkhu himself are giving answers to the question what to do at an ICU from the religious-ethical point of view. The guidelines are existing, following them is a different subject. But it would be too simple to point to this Thai people living between two worlds. A closer look to our own, i.e. western reality reveals that we have some similar division. A separation in medical treatment at University hospitals dominated by machines, therefore inhuman in the imagination of a majority of the population and the natural or holistic movement of the people outside of this centers. The future will show, if we are able to move towards a rather asiatic but also western "way of the middle". The way back to an idealistic postulated former wholeness of human and nature, where problems have been solved by a "natural way", can´t be the target. A new ethical model should include the quintessences of ancient teachings as a fundament for decision making, not as a bondage. An integrative approach on the basis of respecting the will of the individual and trying to avoid suffering of the beings does not contradict ICU-techniques. Both guidelines have been forgotten in Buddhadasa Bhikkhu.

Conclusion
Discrepancy of reality and wishful thinking are the outstanding results of this survey. Physicans are borderliner in a world between the medical possible and the ethical acceptable. Even it is worth an effort to allow religious background having an impact on the decision making in medical therapy, it seems, that not only the clinical reality, but the sole imagination of medical treatment at an ICU is more or less mainly driven by that what is medical possible. As Robertson Smith more than 100 years ago put it: ”Our modern habit is to look at religion from the side of believe rather than of practice”.[12] This techno-cratia (in the sense of ruling) is a trend, what should be reflected. Ethic guideline for medical professionals in situations where they have the power postponing an instant fatal outcome have never been so necessary than today, not only in western countries but everywhere.

Acknowledgement
I would like to express my gratitude to all colleagues of the course Diploma Tropical Medicine & Hygiene at Mahidol University, Bangkok in 1993, who did participate in the survey. Special thanks to Dr. Wiroj Jiamjarasrangsi, Thailand, for the discussion on Theravada-Buddhism, which broadened my mind.
Special regards to my friend and colleague Dr. Wolfgang Hladik, Austria, for giving me the chance to take part in his lectures on atheistic medical ethics.

Literature
[1] Associated press (1998) Bid to boost popularity of Buddhism. Report of the First World Buddhist Propagation Conference, Kyoto, April 1998. The Nation. p. 2

[2] Begleites, E. (1997) Entwurf der Richtlinie der Bundesärztekammer zur ärztlichen Sterbebegleitung und den Grenzen zumutbarer Behandlung. Deutsches Ärzteblatt 94/20, vom 16. Mai 1997, S. 1064f

[3] Buddhadasa Bhikkhu (1986) Handbook of Mankind. Mahamakut Raja. Press. Bangkok. p.31ff

[4] Cummings, J. (1997) Thailand a travel survival kit, Melbourne

[5] Fuchs, T; Lauter, H. (1997) Euthanasie. Kein Recht auf Tötung. Deutsches Ärzteblatt 94/5, vom 31.Jan. 1997, S. 186-188

[6] Hathirat, S. 1993. Death and Dying. The Sunday Post 6/6/1993. p.20

[7] Heinze, R-I. (1988) Trance and Healing in South East Asia today. Bangkok. p.35-37

[8] Kaiser, P. (1995) Traditionelle Thai Massage - Rezeption durch Einheimische und Fremde. Curare 18, 2: 515-530

[9] Ministry of Public Health (ed.) (1990) Thailand Health Profile. Bangkok

[10] N.N. 1993, Reformer of Buddhist teaching. Bangkok Post 29/5/1993. p. 23

[11] Roser, T. (1996) Was darf ein Arzt, und was muß das Gesetz verbieten. STZ vom 5. Jan. 1996, S. 3

[12] Southwold, M. (1983) Buddhism in life. Manchester Univ. Press, Manchester, p. 48f

[13] Tambiah, S.J. (1970) Buddhism and the spirit cults in North-East Thailand. Cambridge Univ. Press, Cambridge

[14] Taylor, J.L. (1993) Forest Monks and the Nation-State: An Anthropological and Historical Study of Northeastern Thailand. Institute of Southeast Asian Studies, Singapore

 

Author:

Dr. med. Dr. phil. Peter Kaiser
Arzt für Allergologie, Naturheilverfahren und Umweltmedizin; Ethnologe und Tropenmediziner
Endersbacherstr. 25 71404 Korb-Kleinheppach, Germany
Tel. 0049-7151-62986
email: Kaiserpeter@t-online.de