Background The potential legalisation of physician assisted suicide (PAS) in the UK has become a hotly debated issue in recent years. Objections from the palliative care community have hitherto been largely based on Judeo-Christian and Humanistic perspectives. In this study the authors argue that the theoretical underpinnings of Buddhist practice also have the potential to add constructively to the debate, without reference to metaphysics.

Aims The aim of this study was to examine traditional Buddhist texts as a means of discovering an alternative set of arguments relevant to palliative care and PAS in terminal illness.

Methods As traditional Buddhist texts make no specific reference to palliative care or PAS, all passages which mention death, dying, illness, killing, kindness, intentionality and moral precepts contained within the five volumes of the Pali Sutta Pitika (the earliest recorded discourses of the Buddha) were selected for analysis. Using an inferential approach, several arguments relevant to palliative care and PAS were revealed. These were then tested for validity by checking for internal consistency within the texts and by analysis using modern applied ethics methods, namely Kantian, consequentialist, virtue ethics and four principles approaches.

Results Several valid arguments in favour of palliative care and against PAS were discovered. Of note are the arguments from karma (that to care for the terminally ill potentially has beneficial effects on carers for the rest of their lives and that to assist in helping others to die has opposite, negative effects), transience (that the inevitability of death makes PAS ultimately unnecessary) and understanding (that for patients embracing life, despite inherent suffering, it can support the cultivation of wisdom and compassion, which benefit the individual and their community).

Conclusions The analysis of traditional Buddhist texts provides novel, strong and relevant arguments in favour of palliative care in terminal illness, and against PAS.