. [...] An unsurpassed, penetrating and perfect dharma is rarely met with even in a hundred thousand million kalpas, having yet to see and listen to, to remember and accept Good morning.

[01:17]

This lecture is dedicated to John King. And I wanted to speak with you this morning without having anything in between us, so I'm not using the lectern. So please excuse any awkwardness or flailing about that I might do with all the props that are part of being a person giving a lecture here. Because when I was thinking about what to speak about this week, I realized that there was a morality play unfolding in front of our very eyes and ears. And I'm talking, of course, about the anesthesiologist's dilemma. So for people who haven't been following the news this week, Monday night,

[02:28]

was scheduled to be the third of three executions by lethal injection in the past 10 weeks. And so the execution was planned. Michael Morales, the man who was to be executed, had his last meal and was in the death watch chamber, and the execution did not proceed. What's today, the 25th? 25th? Okay, so the day before yesterday, I was looking at the internet news and saw these two headlines. Doctors walk out of execution, murderers spared, and

[03:30]

San Quentin forced to indefinitely postpone scheduled lethal injection. Okay, so how did this happen? How did it happen? And now there's a debate going on about the legality of lethal injections. How did it happen that this came to be this week? I realized that the pivotal people in the morality play that was going on this week weren't the criminal, the prisoner, the warden. There weren't good guys and bad guys. The pivotal people were the anesthesiologists who were hired as the... experts in this situation.

[04:31]

So over the last few years there has been a public debate going on about justice and in particular capital punishment. What form of capital punishment is cruel and unusual punishment? So the electric chair gave way to poison gas, which was finally replaced by a system of lethal injection. And they were supposed to be more and more painless and just about justice. Last year, a conservative who was actually in favor of the death penalty questioned whether the drug that was used to anesthetized the person at the beginning of the execution process was painful or not, whether it created pain, because that drug had been outlawed as part of veterinary medicine because it caused pain.

[05:43]

And so the executions that occurred before this third execution were monitored quite closely with the net results that people decided that there was a case that that system did cause pain, undue pain to the person being executed. And so as a third one approached, the defense attorneys for Michael Morales submitted a petition to the state attorney general that something be done about this potentially painful situation. And the state attorney general decided that there would be anesthesiologists monitoring the execution to make sure that there was no undue pain. And so this news was very, this was, this piece of it was very deeply buried, but

[06:47]

the state of California chose two anesthesiologists who were the heads of their respective anesthesiology departments in California hospitals. So very, very expert and well-established professionals to monitor the execution and make sure that there was no undue pain. And That was on February 15th, a couple of weeks ago. So in response to this decision, Jonathan Groner, MD, a clinical associate professor of surgery at Ohio State University College of Medicine and Public Health. He's a national expert on lethal injection. He issued the following statement. An anesthesiologist who enters the death chamber is clearly violating national and internationally established medical ethics.

[07:51]

Not since Nazi physicians supervise the killing of mentally and physically disabled individuals in Germany's notorious euthanasia program have high-ranking physicians become so intimately involved in a state-sponsored killing. and indeed every California physician, should appeal to the anesthesia chief at his or her hospital to stay away from California's death chamber. Physician participation in lethal injection defiles not only those who participate, but the entire medical profession as well. In addition, the American Society of Anesthesia the California Society of Anesthesiologists and the California Medical Association should unconditionally condemn participation in executions by anesthesiologists and by all physicians. So he threw down the gauntlet.

[08:53]

So ASA, the American Society of Anesthesiologists, and AMA, the American Medical Association, both associations of doctors, then put forth statements condemning the presence of doctors in the hall. And it's very interesting. They said that believing in capital punishment itself or not believing in capital punishment itself has nothing to do with their stance because capital punishment belief in capital punishment is not about the practice of medicine. But that participating in the process itself as a physician violates the Hippocratic oath, the vow that all physicians make when they enter the medical profession.

[09:58]

And so the American Society of Anesthesiologists said, physicians are healers, not executioners. The doctor-patient relationship depends on the inviolate principle that a doctor uses his or her medical expertise only to benefit patients. And the AMA said something similar and added that participation includes any actions that directly cause death, any actions that assist or supervise in the situation, and any action that would automatically cause an execution to be performed. So AMA was very stringent and did not, but at the same time, did not take a position on whether people convicted of murder should be executed or not. So immediately there was a lot of debate among people who found out about this.

[11:06]

Hippocratic Oath, the ACLU said, the state says a doctor will be there to monitor executions, but what does this mean? Will scientific instruments be used? Will the doctor stand there and watch? So there was a lot of debate. And the Department of Corrections position was the anesthesiologists and the prison administration will have to work out what is an ethical participation. And even Michael Morales' close friends felt torn. Their statements appear on the web. felt torn about whether an anesthesiologist should participate or not, because should their friend who was about to die be subject to extra pain during the process? And conservatives and liberal people alike took all sorts of positions.

[12:17]

When you look at the positions that people took, It doesn't split out that people on the right took one position and people on the left took another. All the positions are all over the map. So let me just tell you what the Oath of Hippocrates actually is. How many people have kind of a familiarity with it already? Okay, so about half it looks like. So this oath of Hippocrates that doctors take at the beginning of their career is very ancient. It comes from the time of ancient Greece. And before then, doctors could both heal or kill, depending on what was appropriate in the situation. But at the time of the ancient Greek debates on ethics,

[13:19]

Western medicine developed a Hippocratic Oath, and it was actually authored by a physician named Hippocrates. And this is a translation of his original oath. I swear by Apollo, the physician, and Esulepius, and health, and all heal, and all the gods and goddesses, that according to my ability and judgment, I will keep this oath. To reckon him who taught me this art equally dear to me as my parents. To share my substance with him and relieve his necessities if required. So the part is about, the first part is about the teacher. So it's basically to treat the teacher well. And also how you will pass on your knowledge. I will follow that method of treatment which according to my ability and judgment I consider for the benefit of my patients and abstain from whatever is deleterious and mischievous.

[14:22]

I will give no deadly medicine to anyone if asked, nor suggest any such counsel. Furthermore, I will not give to a woman instruments to produce abortion. With purity and with holiness, I will pass my life and practice my art. I will not cut a person who is suffering with stone. but will leave this to be done by practitioners of that work. Into whatever houses I enter, I will go into them for the benefit of the sick and will abstain from every voluntary act of mischief and corruption and further from the seduction of females or males, bond or free. Whatever in connection with my professional practice or not in connection with it, I may see or hear in the lives of men which ought not to be spoken. I will not divulge as reckoning that all such should be kept secret. While I continue to keep this oath unviolate, may it be granted to me to enjoy life and the practice of my art, respected by all men at all times.

[15:32]

But should I trespass or violate this oath, may the reverse be my lot. So I thought it was worthwhile to read the original oath, even though it's been changed over time. And in the modern oath, still, the first part of it is, first, do no harm. And that's very in line with the precepts and also with many ethical codes around the world. So... What actually happened that night? So I was at San Quentin. I was sitting doing vigil in front of the gates with both supporters and opposers of the death penalty. Supporters and opposers alike were sitting quietly. There was very little heckling. It was freezing cold. Nobody was in the mood. But what there was was just waiting, waiting.

[16:38]

on supporters of the death penalty waiting to see justice performed, and opposers of the death penalty waiting in silent vigil that somebody was going to be killed. So at about 10.30, a discussion began during the training of the anesthesiologist who was going to stand by. And at about 11.30, we received word that the warden had delayed the execution for an hour because there were some problems with the training. What actually happened was that the training of an anesthesiologist in this case is that they do a walkthrough of the execution as it's about to happen in exactly the way that it will occur. So it's kind of a run through. And so at that point, the first anesthesiologist backed out.

[17:41]

And then they went to the second anesthesiologist. And then the second anesthesiologist backed out. And the anesthesiologist and the prison warden engaged in a conversation about what was appropriate for a doctor to do. They were still in conversation at 2 o'clock in the morning, according to prison spokesman Vernal Crittenden. The anesthesiologist ended the discussion sometime between 2 o'clock and 2.30 by saying that they could not be involved in the process. After a few more minutes, the warden stood down from carrying out the execution, and it was rescheduled to Tuesday night at 7 p.m. During the day, The U.S. District Court, the Ninth Circuit Court, decided that the alternate method that the state had said was okay on February 15th, a single injection of an overdose of barbiturates, would have to have a licensed medical person as well.

[18:56]

And the state could not find someone to do it, and so the death warrant expired. And... The death warrant for a criminal only lasts a certain amount of time, and it has to be renewed. If it expires, it has to be renewed by the person, the judge, who originally set the warrant. But the original warrant was set by a judge who has since come to believe that the death penalty was not justified in this particular case. stopped believing in the testimony of a jailhouse informant who said that Michael Morales had said something to him in Spanish. Michael Morales did not speak Spanish, so the judge stopped believing in the case that he had acted on originally. And so now the execution is delayed until at least May when it will be argued once again

[20:01]

And the word is that there's a high chance that it will go to the Supreme Court. So as you can imagine, there's a debate all over the country, particularly among medical professionals, as to whether lethal injection is legal, and if so, how. And... But let's go to Buddhist practice. You've been waiting patiently for me to get to the Buddhist practice part of this talk. So as part of studying for this talk or preparing for this talk, I spoke with various medical people who are practitioners and asked them what they thought, who are Zen practitioners. And so maybe the representative of the people I talk to, the best representative, is Dr. Bill Stewart, who's been practicing for about 25 years.

[21:04]

And he is in charge of the Center for Health and Healing at California Pacific Medical Center. And he said that the role of the anesthesiologist is... what the anesthesiologist said and did is consistent with what the professional associations suggest ethically. He said that when the person actually sits there in the room and goes into the training, then it becomes an act of conscience. Then it becomes personal. That the anesthesiologists... there can be various arguments about whether it's okay or whether there's something prohibiting them from participating, but that when you're actually in the room, you personally have to decide what to do. No one else can decide on your behalf.

[22:06]

And he said that he can understand this very well from his experience as a physician, that physicians often have to think, doctors often have to think, am I capable of helping this person die? You know, whether they help someone die or whether they don't help someone die. Sometimes they see people in enormous suffering, so it really becomes part of what they face on a day-to-day basis, doctors and nurses. And he said that even if it's legal, the doctor has to think, is this a justified law or not? Can I follow the law or can't I? There have been many societies in which killing people was justified. And, for instance, the best known example is in Nazi Germany, where a doctor could say, I was doing my job.

[23:13]

He cannot argue either the stance of the physician or the stance of the ANA, and he understands it very well from his own personal experience. So, you know, there is nothing physically different about anesthesiologists from the rest of us. We have all the same equipment as an anesthesiologist, and we would be faced with the same decision if we were in that room. And so, you know, take a look around you and you won't see any, if you look at people's faces and bodies, you won't see anything about people that says, I would decide this way or I would decide that way. I mean, look at the people around you. Do you see anything that sticks out like a flag and says, yes, I would make this decision or no, I would make that decision? You can't. But there is a kind of a form that you can't see that's actually invisible to us that is, in fact, nevertheless a very real part of our lives.

[24:28]

And that's the mental, psychological, and emotional structure that continues in us and that we perceive to be an unbroken life stream. And so the kind of form that you can't see, but that we can perceive and understand, we can kind of infer it, we can perceive our behavior in relation to our past, and we have a sense of our present volition. And that sense that changes when we do something like kill somebody or help somebody be killed is called avishnyapti rupa. And rupa means form, and you hear about it in the Heart Sutra. No color, no sound, no smell, no taste, no touch, no object of mind. So color is form.

[25:29]

Color and shape is form. Avijñati just means you can't cognize it, you can't see it or feel it. And it's a serial continuity that depends on stuff that you can see or feel. And it's made up of matter and action. It transforms with your volition and with your action. So suppose that you have never killed anyone or anything. And one day you hear that West Nile virus is transmitted by a certain type of mosquito. And your house has a lot of mosquitoes in it because it's that time of year. And so you see a mosquito, and although you've never killed anyone or anything, you think, West Nile, splat.

[26:38]

Okay? So then... there's a tiny little change to your mental life, which makes it easier for you to kill a mosquito next time. So let's say that it's a more serious action, like killing a person, planning a killing, killing itself, or having killed a person. Then there's a very strong mental change precedent for being violent in the future. And so, Avishnapti is not only negative, it's also positive. So say that there's something in you, which I believe about everyone in this room, that is awake. Let's say that you're of the very nature of awakeness.

[27:42]

but you don't really believe that about yourself. There's nothing in your life which actually has prepared you to be an awakened person. And there's a story about this in the Lotus Sutra, that there was once a son who was the heir of his father, but he didn't really That was not what was utmost in his mind. Let's say he was maybe a teenager and he ran away from home and did various things. And the father mourned his son. He missed his son. And he couldn't... It wasn't the same life without his son. And one day in the marketplace, the father saw his son and he was all... wearing rags, and he looked like a street person. And the father knew, oh, if I go up to my son and acknowledge him, he'll run away again.

[28:48]

What'll I do? So the father sent a man who worked for him to approach the son and say, I have day work in exchange for a place to sleep. And so the man approached the son and said, there's a wealthy man who has some day work, and if you do this, and it's just an hour or two, you can sleep in the stable on the straw. And the son said, oh, sounds great. And he did the hour or two of work and slept. And the next day, the servant approached and said, well, If you want to make this a regular arrangement, any time you feel like working will give you a place to sleep. Anyway, it continued like that, with gradually the sleep turning into sleep and food, turning into a little bit of compensation.

[29:52]

And finally, until finally the son was in charge of the stables. And at that point, the father came and approached the son and said, I want it all this time I've been watching you from afar. I'm the wealthy person and I'm your father. And that's the end of the story. That the son was able to realize that he was his father's heir. And he was able to realize his father's love, maybe in a new way for the first time. So that's the story about Avishnapti Rupa. And it has to do with your volition, your intention, and your actions. So Avijjnapti is not an organ. It can't be operated on or changed in that way.

[30:53]

It's subtle. And it's an outflowing. It's either good or bad. It's good, it tends to good results or it tends to bad results. It's never just neutral. And it doesn't belong to tatami mats or cars or anything like that. I mean, even though we like to talk to our cars and our possessions, if you talk to the car, it doesn't generally make it work better. And it's not about the world of deep concentration. It's about the world that we live in and function in every day. So I want to make it known. So the Avishnapti of the Hippocratic Oath, I think, is what made the difference in this situation.

[32:04]

for the anesthesiologists. And so the Buddha teaches about that. But I want to also say that Avishnapti is not just the property of the anesthesiologist. Avishnapti also has to do with the oaths of everyone in the situation. The warden took an oath. The lawyer took an oath. took an oath. Both the defense and the prosecuting attorneys took oaths. But listen to the difference between the Hippocratic oath, which you heard before, and the lawyer's and warden's oath. Here's a lawyer's oath or a warden's oath. This oath is taken in the state of California by anyone in a public position. And something very similar is taken in the case where lawyers take oaths, I so-and-so do solemnly swear or affirm, if they're just have already received that, that I will support and defend the Constitution of the United States and the Constitution of the State of California against all enemies, foreign and domestic.

[33:25]

that I will bear true faith and allegiance to the Constitution of the United States and State of California, that I take this obligation freely without any mental reservation or purpose of evasion, and that I will well and faithfully discharge the duties upon which I am about to enter." And then there's more about not harboring enemies or being an enemy of of the Constitution, but can you hear the difference between the oaths that the warden and the lawyers took and the oaths that the doctors took? So the warden's oath and the lawyer's oath do not necessarily make it as personal in the same way. And Michael Morales has a Vishnaptirupa.

[34:29]

He was convicted of a horrendous crime 25 years ago. And the word is that he has sincerely repented of that crime. Now that doesn't change what he did, but his life stream has changed in such a way that he was able to approach execution. and not only approach it, but stay in the room, and not only stay in the room once, but stay in the room twice with dignity. And I would like at this point to read, what I've been talking about is conventional truth, conventional wisdom. The Buddha taught three types of wisdom, conventional, ultimate, and skillful. So conventional wisdom is the wisdom that's of this world. Ultimate wisdom, ultimate truth is that nothing is the way we think it is.

[35:30]

And skillful truth is when we have to decide what to do based on our understanding of ultimate truth and of conventional truth. So the best statement of non-killing or non-harm that I found in the conventional realm that goes with our tradition is found in the Brahmajala Sutra. And I'd like to read that because in Zen we say, I vow not to kill. And we also say there is no killing. So... I vow not to kill means in conventional life I will not kill. The ultimate understanding is that there is no killing, that life is not killed. But if you're faced with killing a mosquito, putting your cat to sleep, killing a human being, and so on, you can't just say, oh, life is not killed, so it's okay.

[36:45]

In the conventional world, there are consequences to conventional killing. So here's a statement from the Brahmajala Sutra. The Buddha said, Buddha children, if you yourselves kill, encourage others to kill, facilitate or praise killing, take pleasure in seeing it done, or even kill with a curse. If you are involved in the causes, conditions, methods, or circumstances of killing, even if you never deliberately kill anything living, even if you always arouse compassionate and filial thoughts proper to an awakened being and use skillful means to help everyone, But in your action, you turn and take life with an unrestrained mind full of quick passions. Any of these cases puts you outside the help of the Buddha's teaching.

[37:52]

So that's from the Brahmajava Sutra. And so the causes, conditions, methods, or circumstances of killing, if you're involved with them, then at that moment, and maybe even for some time to come, you would be unable to be helped by your own awakened nature or that of other people. So that's in the conventional world. Okay, so this is a very serious, very deep topic, and I don't want it to be grim. But I did feel like it was necessary to talk about this on this Saturday morning, this beautiful, bright Saturday morning in which we can go out into the park or go shopping and not have to think, oh, one more thing I forgot to say.

[39:00]

The anesthesiologists could have been masked. no one would have been able to identify them. Okay? So, what would you do? What would you do? The Buddha's teaching is, you know, we are the anesthesiologist. I am the anesthesiologist. Not to mention, I am Michael Morales. I am Terry Winchell, Michael Morales' victim. I am the family of Terry Winchell that feels betrayed by the state because it's a mockery of justice. I am the judge who had to decide. I am the warden who had to make sure that justice was done according to the law.

[40:06]

We are the anesthesiologist, so what would you do? What would you do? May our intention equally send to every...

[40:33]

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