Buddhism places great importance on intention (cetana) in evaluating the ethical weight of any action. This is especially true in cases where death results from a decision or action, but was not the intended outcome. Such scenarios are treated differently from acts of euthanasia or suicide, where death is the explicit aim.
One of the most discussed cases involves pain relief for the terminally ill. As a patient’s tolerance to painkillers like morphine increases, the dosage may need to be raised to levels that eventually cause death. In such situations, the primary intention is to relieve pain, not to end life. This distinction between intention and foresight is crucial in Buddhist ethics. One may foresee that an action might cause death, but if death is not the intended goal, the action is not considered ethically equivalent to killing .
This principle is echoed in the Vinaya, the monastic code. A case is recorded where a monk dies after being administered medicine by other monks. If the medicine was given to help, and not to kill, the monks are held not guilty of any offence. However, if the medicine was given with the intention to end the monk’s life, the act becomes a grave offence, nearly equivalent to expulsion from the Saṅgha .
The ethical acceptability of such scenarios has led some modern scholars to use the term “passive euthanasia” in these cases — though many argue that this term is misleading. It’s more accurate to describe these as cases of non-intended death, where compassion guided the action, but without a deliberate aim to end life .
Another situation includes cases where burdensome medical treatment is withheld or discontinued. For instance, a patient may choose to forego further rounds of chemotherapy that are painful, expensive, and unlikely to succeed. If the aim is not to die, but to preserve the quality of life in remaining days, this is not seen as unethical. To continue treatment in such cases, some argue, would be “to flail against the forces of impermanence,” contrary to Buddhist wisdom on letting go .
A third scenario involves compassionate withdrawal from life-sustaining support. A patient, concerned about exhausting their family’s finances or medical resources, might decide to stop intensive care. As long as this decision is made freely and not under pressure, and the aim is not death itself, such an action can be morally acceptable — though the emotional and karmic nuances must be weighed carefully .
In all these cases, Buddhism distinguishes sharply between actions done with the intention to kill and those where death is a foreseen but unintended consequence. This subtle but essential ethical principle helps preserve both compassion and moral clarity.