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While reading an answer to How to overcome the suffering of attachement to the body's continued existence (in Western modernity)?, I began to wonder about a related matter.

In the answer:

In preparation for death you should:
1) accept the fact everyone must die and let go of the fear of death

OK, but how about this situation:

Let's say I have terminal cancer, and the doctor says I will only live another 6 months. However, if I get some difficult treatment (let's say chemotherapy that often causes severe pain), I may live up to 10 years longer.

So from a Buddhism point of view:
1) Would there be any concern if I didn't get any treatment? It isn't suicide, but I am not taking an action will hasten death.

2) Would there be any concern if I did get the treatment? Does that imply a fear of death, by postponing the inevitable? And since a goal of Buddhism is to reduce suffering, while understanding pain can be managed, can voluntarily increasing ones suffering be justified?

In each case, is there any impact on karma looking to the next rebirth?

Finally, I am not referring to medical treatment in general. Only when it is very invasive and severely impacts ones normal life (and lifespan).

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Here are some quotes from commentaries on the monastic rules.

The Bhikkhus' Rules -- A Guide for Laypeople

Properly considering medicinal requisites for curing the sick, I use them: simply to ward off any pains of illness that have arisen, and for the maximum freedom from disease.

Also, "praising the advantages of dying" is considered in the same category as "intentionally causing death":

Should any bhikkhu intentionally deprive a human being of life, or search for an assassin for him, or praise the advantages of death, or incite him to die (saying): “My good man, what use is this evil, miserable life to you? Death would be better for you than life,” or with such an idea in mind, such a purpose in mind, should in various ways praise the advantages of death or incite him to die, he also is defeated and no longer in affiliation.

The Khandhaka Rules

“A sick person endowed with five qualities is hard to tend to: He does what is not amenable to his cure; he does not know the proper amount in things amenable to his cure; he does not take his medicine; he does not tell his symptoms, as they actually are present, to the nurse desiring his welfare ...

I think the above implies that the patient has some kind of duty of care towards their nurse (as well as vice versa).

The Patimokkha Rules

The Commentary extrapolates from this case to apply the dukka˛a to all attempts at suicide, including even the decision not to take food when motivated by a desire to die. However, it then runs into the question of how far this penalty applies to a bhikkhu who is ill. Its verdict: As long as medicine and attendants are available to him, the penalty would still apply. But then it lists two cases where the penalty would not apply: (a) A bhikkhu is suffering from a long and serious illness, and the attendant bhikkhus are fed up with caring for him, thinking, “When will we be free of this sick one?” If the bhikkhu reflects that, even with medical care, his body won’t last and that the bhikkhus are being put to difficulties, he incurs no penalty in refusing food and medicine. (b) A bhikkhu— reflecting that his illness is harsh, the forces of life are running out, and yet the noble attainments appear to be within his reach—may refuse food and medicine without penalty.

The Commentary’s deliberations here show how difficult it is to legislate in this area, and there are reasons to question the way it applies the Great Standards here. Case (b) is apparently derived from SN 4.23, where Ven. Godhika takes his life and gains arahantship just moments before death; and from SN 35.87, where the Buddha says that one who puts down this body without taking up another body dies blamelessly. However, in arriving at its verdict in this case, the Commentary has to add the factors of motivation and perception to the equation, factors that are absent from the rule on which the judgment is based. It also leaves unanswered the question of how harsh the 86 disease has to be, and how near the anticipated attainments, to qualify for this exemption.

This same holds true for case (a), which entails even more dubious reasoning. The Commentary’s judgment here has no clear precedent in the Canon; there is no clear line for deciding exactly how bad the illness and how fed up the attendants have to be for this case to apply; and why should the feelings of other people determine when it is or is not allowable to refuse food?

It is worth noting that the origin story to the original rule here gave the Buddha the opportunity, had he wanted it, to formulate a general rule against attempted suicides, but he chose not to. He later formulated this subsidiary rule only when a bhikkhu attempted a suicide in a way that endangered the life and safety of another person. Thus a more appropriate way of applying the Great Standards to this subsidiary rule would be to extend it only to cases of that sort: where a bhikkhu’s attempts at suicide would bring danger to another person’s life and limb.

As for ways of attempting suicide that do not endanger others, it seems better to follow the Buddha’s wisdom in not legislating about this issue at all, and to treat it as a matter of Dhamma rather than Vinaya. In other words, one should keep in mind his comment in SN 35.87 that the only blameless death is an arahant’s. If, lacking that attainment, one chooses to refuse food when ill to speed up one’s death, one should be heedful of the risks that death and rebirth can involve.

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Human life is rare and precious hence prolonging it maybe a good option or a person who is not liberated yet. This gives more room for pratice on case your next birth is not conducive for pratice.

The motivation in refusing medication can happen due to few factors:

  • A deluded ideal or wrong view; for example:

    • "I have done my part for the world" (i.e. I-centered)
    • "Everyone has a right to decide whether to live or die" (i.e. no belief of karmic retribution)
    • "When I die the suffering will be over" (i.e. no belief of after life)
  • Aversion towards to sickness

If any of the above cases are the motivation then this is not a Buddhist take on the matter as thinking has unwholesome roots. In the 1st instance you are holding on to some ideal or view either originating or leading to foster unwholesome roots; and in the latter you are averse towards the condition. Hence you are unlikely to get a good birth in the next life by either choice if you refuse medication.

In principle if you do it the Buddhist way then you have to try to understand the 4 Noble Truths in experiences due to the sickness or otherwise and Dependent Origination of the condition during your sickness or otherwise. One of the main links for both is sensations / feeling / unsatisfactoriness which you should look at them closely being equanimous and seeing the arising from start to the end. Due to the greater pain of the sickness you might miss more subtle sensation. You have to be attentive to the also.

Also please take time to read:

  • Are you saying that any view (or understanding) cannot be a right (Buddhist) reason for doing something, i.e. that no view is right? Or were you saying only that those specific views aren't right? – ChrisW Jan 26 '16 at 10:47
  • Any views that can lead to unwholesome action in not right. – Suminda Sirinath S. Dharmasena Jan 26 '16 at 13:57
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It all depends on each individual's unique situation. If s/he is an ascetic or a lay person who is not married and has no kids, then one can afford the option to let one's condition runs its natural course without introducing a mean to prolong one's life. On the other hand, if one is a lay person who's the breadwinner for his family with spouse, kids, or maybe old parents, then one'd need to do whatever it takes to prolong one's life. This is why the Buddha said living the lay life is difficult for one's life is invariably tied to his loved ones and he has to fulfill his obligation to take care of his wife and kids.

Household life is confining, a dusty path. The life gone forth is like the open air. It is not easy living at home to practice the holy life totally perfect, totally pure, like a polished shell.. ~ DN 2

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the fact that one refuses treatment which may prolong one's life doesn't indicate that one's free from attachment to the body and to being

detachment must be genuine, based on insight into the nature of phenomena and existence

while consent to accept treatment and thus extension of one's lifespan may increase one's chances to attain real detachment through continuing practice

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