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Monday, May 9, 2022

Buddhist crisis

From Wikipedia, the free encyclopedia
 
Buddhist Crisis
Part of the Vietnam War
Thích Quảng Đức self-immolation.jpg
Thích Quảng Đức's self-immolation
DateMay–November 1963
Location
Resulted in1963 South Vietnamese coup
Parties to the civil conflict
Buddhists of South Vietnam
South Vietnam South Vietnamese government
Lead figures
Thich Tri Quang Ngô Đình Diệm

The Buddhist crisis (Vietnamese: Biến cố Phật giáo) was a period of political and religious tension in South Vietnam between May and November 1963, characterized by a series of repressive acts by the South Vietnamese government and a campaign of civil resistance, led mainly by Buddhist monks.

The crisis was precipitated by the shootings of nine unarmed civilians on May 8 in the central city of Huế who were protesting a ban of the Buddhist flag. The crisis ended with a coup in November 1963 by the Army of the Republic of Vietnam (ARVN), and the arrest and assassination of President Ngô Đình Diệm on November 2, 1963.

Background

In South Vietnam, a country where the Buddhist majority was estimated to comprise between 70 and 90 percent of the population in 1963, President Ngô Đình Diệm's pro-Catholic policies antagonized many Buddhists. A member of the Catholic minority, Diệm headed a government biased towards Catholics in public service and military promotions, as well as in the allocation of land, business favors, and tax concessions. Diệm once told a high-ranking officer, forgetting that he was a Buddhist, "Put your Catholic officers in sensitive places. They can be trusted." Many ARVN officers converted to Catholicism in the belief that their career prospects depended on it, and many were refused promotion if they did not do so. Additionally, the distribution of firearms to village self-defense militias intended to repel Viet Cong guerrillas was done so that weapons were only given to Catholics. Some Catholic priests ran private armies while forced conversions, looting, shelling and demolition of pagodas occurred in some areas. Several Buddhist villages converted en masse to receive aid and to avoid forced resettlement by Diệm's regime.

The Catholic Church was the largest landowner in the country, and the "private" status that was imposed on Buddhism by the French, which required official permission to conduct public activities, was not repealed by Diệm. The land owned by the church was exempt from land reform, and Catholics were also de facto exempt from the corvée labor that the government obliged all other citizens to perform; public spending was disproportionately distributed to Catholic majority villages. Under Diệm, the Catholic Church enjoyed special exemptions in property acquisition, and in 1959, he dedicated the country to the Virgin Mary. The Vatican flag was regularly flown at major public events in South Vietnam. Earlier in January 1956, Diệm enacted Order 46 which permitted "Individuals considered dangerous to the national defense and common security [to] be confined by executive order, to a concentration camp." This order was used against dissenting Buddhists. The infamous action later caused anger inside its people, with lend to some of the minority supported or joined The Liberation Army of South Vietnam.

Events

May 1963

A rarely enforced 1958 law—known as Decree Number 10—was invoked in May 1963 to prohibit the display of religious flags. This disallowed the flying of the Buddhist flag on Vesak, the birthday of Gautama Buddha. The application of the law caused indignation among Buddhists on the eve of the most important religious festival of the year, as a week earlier Catholics had been encouraged to display Vatican flags at a government-sponsored celebration for Diệm's brother, Archbishop Ngô Đình Thục, the most senior Catholic cleric in the country. On May 8, in Huế, a crowd of Buddhists protested against the ban on the Buddhist flag. The police and army broke up the demonstration by firing guns at and throwing grenades into the gathering, leaving nine dead.

In response to the shootings in Huế, Buddhist leader Thích Trí Quang proclaimed a five-point "manifesto of the monks" that demanded freedom to fly the Buddhist flag, religious equality between Buddhists and Catholics, compensation for the victims' families, an end to arbitrary arrests, and punishment of the officials responsible. The request was formalized on 13 May, and talks began on 15 May.

Diệm denied governmental responsibility for the incident. Instead, the president blamed the Viet Cong for the event. Diệm's Secretary of State Nguyen Dinh Thuan accused the Viet Cong of exploiting Buddhist unrest and declared that Diệm could not make concessions without fueling further demands. The Vietnam Press, a pro-Diệm newspaper, published a government declaration confirming the existence of religious freedom and emphasizing the supremacy of the country's flag. Diệm's National Assembly affirmed this statement, but this did not placate the Buddhists. In one meeting, Diệm labeled the Buddhists "damn fools" for demanding something that according to him, they already enjoyed. The government press release detailing the meeting also used the expression "damn fools". On May 18, President Diệm agreed a modest compensation package of US$7000 for the families of the victims of the shootings in Huế. Diệm also agreed to dismiss those responsible for the shootings, but on the grounds that the officials had failed to maintain order, rather than any responsibility for the deaths of the protesters. He resolutely continued to blame the Viet Cong.

On May 30, more than 500 monks demonstrated in front of the National Assembly in Saigon. The Buddhists had evaded a ban on public assembly by hiring four buses, packing them with monks, and closing the blinds. They drove around the city until the convoy stopped at the designated time and the monks disembarked. This was the first time an open protest had been held in Saigon against Diệm in his eight years of rule. They unfurled banners and sat down for four hours before disbanding and returning to the pagodas to begin a nationwide 48-hour hunger strike organized by the Buddhist patriarch Thich Tinh Khiet.

June 1963

On June 1, Diệm's authorities announced the dismissal of the three major officials involved in the Huế incident: the provincial chief and his deputy, and the government delegate for the Central Region of Vietnam. The stated reason was that they had failed to maintain order. By this time, the situation appeared to be beyond reconciliation.

On June 3, amid nationwide protests in Saigon and other cities, Vietnamese police and ARVN troops poured chemicals on the heads of praying Buddhist protestors in Huế outside Từ Đàm Pagoda. Sixty-seven people were hospitalized and the United States privately threatened to withdraw aid.

Diệm responded to the controversy of the chemical attacks by agreeing to formal talks with the Buddhist leaders. He appointed a three-member Interministerial Committee, which included Vice President Nguyễn Ngọc Thơ as chairman, Thuan, and Interior Minister Bui Van Luong. The first meeting with Buddhist leaders took place two days after the attacks and one of the issues discussed was the standoff in Huế, and the cessation of protests if religious equality was implemented. Diệm appeared to soften his line, at least in public, in an address on 7 June when he said that some of the tensions were due to his officials lacking "sufficient comprehension and sensitivity" although there was no direct admission of fault regarding any of the violence in Huế since the start of the Buddhist crisis.

On June 11, Buddhist monk Thích Quảng Đức burned himself to death at a busy Saigon road intersection in protest against Diệm's policies.

In response to Buddhist self-immolation as a form of protest, Madame Nhu—the de facto First Lady of South Vietnam at the time (and the wife of Ngô Đình Nhu, who was the brother and chief advisor to Diệm)—said "Let them burn and we shall clap our hands", and "if the Buddhists wish to have another barbecue, I will be glad to supply the gasoline and a match."

Acting US Ambassador William Trueheart warned that without meaningful concessions, the US would publicly repudiate Diệm's regime. Diệm said that such a move would scupper the negotiations. On June 14, Diệm's committee met with the Buddhists, who lobbied for Diệm to immediately amend Decree Number 10 by presidential decree as allowed in the constitution, rather than wait for the National Assembly to do so. The National Assembly had announced a committee would be established on June 12 to deal with the issue. Trueheart recommended that the Interministerial Committee accept the Buddhist's position in a "spirit of amity" and then clarify the details at a later point. During the negotiations, Thích Tịnh Khiết issued a nationwide plea to urge Buddhists to avoid any actions that could endanger the talks while Diệm ordered government officials to remove all barriers around the temples.

On 16 June, an agreement between the committee and the Buddhists was reached. An agreement had been reached pertaining to all five demands, although the terms were vague. Diệm claimed it contained nothing that he had not already accepted. The "Joint Communique" asserted that the national flag "should always be respected and be put at its appropriate place". The National Assembly would consult with religious groups in an effort to remove them "from the regulations of Ordinance No. 10" and to establish new guidelines appropriate to their religious activities. In the meantime the government committee promised a loose application of the regulation. It also promised leniency in the censorship of Buddhist literature and prayer books and the granting of permits to construct Buddhist pagodas, schools and charitable institutions.

Both sides agreed to form an investigative committee to "re-examine" the Buddhist grievances and Diệm agreed to grant a full amnesty to all Buddhists who had protested against the government. The agreement stated the "normal and purely religious activity" could go unhindered without the need for government permission in pagodas or the headquarters of the General Association of Buddhists. Diệm promised an inquiry into the Huế shootings and punishment for any found guilty, although it denied government involvement. In an attempt to save face, Diệm signed the agreement directly under a paragraph declaring that "the articles written in this joint communiqué have been approved in principle by me from the beginning", which he added with his own handwriting, thereby implying that he had nothing to concede.

The Joint Communiqué was presented to the press on 16 June and Thích Tịnh Khiết thanked Diệm and exhorted the Buddhist community to work with the government. He expressed his "conviction that the joint communiqué will inaugurate a new era and that ... no erroneous action from whatever quarter will occur again." He declared that the protest movement was over, and called on Buddhists to return to their normal lives and pray for the success of the agreement. However, some younger monks were disappointed with the result of the negotiations feeling that Diem's regime had not been made accountable.

Trueheart was skeptical about its implementation, privately reporting that if Diệm did not follow through, the US should look for alternative leadership options. The troubles had become a public relations issue for Diem beyond his country, with speculation about a US-Diệm rift being discussed in American newspapers following the self-immolation. The New York Times ran a front page headline on 14 June, citing leaked government information that diplomats had privately attacked Diem. It also reported that General Paul Harkins, the head of the US advisory mission in South Vietnam, ordered his men not to assist ARVN units that were taking action against demonstrators. The US at the time considered telling Vice President Tho that they would support him replacing Diem as President. This occurred at the same time as the surfacing of rumours that Republic of Vietnam Air Force Chief of Staff Lieutenant Colonel Đỗ Khắc Mai had begun gauging support among his colleagues for a coup.

The agreement was put in doubt by an incident outside Xá Lợi Pagoda the following day. A crowd of around 2,000 people were confronted by police who persisted in ringing the pagoda despite the agreement. A riot eventually broke out and police attacked the crowd with tear gas, fire hoses, clubs, and gunfire. One protester was killed and scores more injured. Moderates from both sides urged calm while some government officials blamed "extremist elements". An Associated Press story described the riot as "the most violent anti-Government outburst in South Vietnam in years". Furthermore, many protesters remained in jail contrary to the terms of the Joint Communique. The crisis deepened as more Buddhists began calling for a change of government and younger monks such as Thích Trí Quang came to the forefront, blaming Diệm for the ongoing impasse. Due to the failure of the agreement to produce the desired results, older and more senior monks, who were more moderate, saw their prestige diminished, and the younger, more assertive monks began to take on a more prominent role in Buddhist politics.

Thich Tinh Khiet sent Diệm a letter after the funeral of Thích Quảng Đức, noting the government was not observing the agreement and that the condition of Buddhists in South Vietnam had deteriorated. Tho denied the allegation, and Ngô Đình Nhu told a reporter: "If anyone is oppressed in this affair, it is the government which has been constantly attacked and whose mouth has been shut with Scotch tape." He criticised the agreements through his Republican Youth organization, calling on the population to "resist the indirections [sic] of superstition and fanaticism" and warned against "communists who may abuse the Joint Communique". At the same time, Nhu issued a secret memorandum to the Republican Youth, calling on them to lobby the government to reject the agreement, and calling the Buddhists "rebels" and "communists". Nhu continued to disparage the Buddhists through his English-language mouthpiece, the Times of Vietnam, whose editorial bent was usually taken to be the Ngô family's own personal opinions.

A US State Department report concluded that the religious disquiet was not fomented by communist elements. In the meantime the government had quietly informed local officials that the agreements were a "tactical retreat" to buy time before decisive putting down the Buddhist movement. Diệm's regime stalled on implementing the release of Buddhists who had been imprisoned for protesting against it. This led to a discussion within the US government to push for the removal of the Nhus, who were regarded as the extremist influence over Diệm, from power.

The Buddhists were becoming increasingly skeptical of government intentions. They had received information that suggested that the agreement was just a governmental tactic to buy time and wait for the popular anger to die down, before Diệm would arrest the leading Buddhist monks. They began to step up the production of critical pamphlets and began translating articles critical of Diệm in the Western media to distribute to the public. As promises continued to fail to materialise, the demonstrations at Xá Lợi and elsewhere continued to grow.

July 1963

In July, Diệm's government continued to attack the Buddhists. It accused Thích Quảng Đức of having been drugged before being set alight. Tho speculated that the Viet Cong had infiltrated the Buddhists and converted them into a political organization. Interior Minister Luong alleged that cabinet ministers had received death threats. Henry Cabot Lodge, Jr. was announced as the new US ambassador effective in late August, replacing Frederick Nolting, who was considered too close to Diệm.

On July 7, 1963, the secret police of Ngô Đình Nhu attacked a group of journalists from the United States who were covering Buddhist protests on the ninth anniversary of Diem's rise to power. Peter Arnett of the Associated Press (AP) was punched in the nose, but the quarrel quickly ended after David Halberstam of The New York Times, being much taller than Nhu's men, counterattacked and caused the secret police to retreat. Arnett and his colleague, the Pulitzer Prize-winning journalist and photographer Malcolm Browne, were later accosted by police at their office and taken away for questioning on suspicion of attacking police officers. In the end, Diem agreed to have the charges against Browne and Arnett dropped after intervention from the US Embassy.

On the same day, Diem publicly claimed that the "problems raised by the General Association of Buddhists have just been settled." He reinforced perceptions that he was out of touch by attributing any lingering problems to the "underground intervention of international red agents and Communist fellow travelers who in collusion with fascist ideologues disguised as democrats were surreptitiously seeking to revive and rekindle disunity at home while arousing public opinions against us abroad."

August 1963

On Sunday, August 18, the Buddhists staged a mass protest at Xá Lợi Pagoda, Saigon's largest, attracting around 15,000 people, undeterred by rain. The attendance was approximately three times higher than that at the previous Sunday's rally. The event lasted for several hours, as speeches by the monks interspersed religious ceremonies. A Vietnamese journalist said that it was the only emotional public gathering in South Vietnam since Diem's rise to power almost a decade earlier. David Halberstam of The New York Times speculated that by not exploiting the large crowd by staging a protest march towards Gia Long Palace or other government buildings, the Buddhists were saving their biggest demonstration for the scheduled arrival of new US ambassador, Henry Cabot Lodge Jr., the following week. As a government attack on Xa Loi was anticipated, Halberstam concluded that the Buddhists were playing "a fast and dangerous game". He wrote that "the Buddhists themselves appeared to be at least as much aware of all the developments, and their protest seemed to have a mounting intensity".

On the evening of August 18, ten senior ARVN generals met to discuss the situation and decided that martial law needed to be imposed. On August 20, Nhu summoned seven of the generals to Gia Long Palace for consultation. They presented their request to impose martial law and discussed dispersion of the monks. Nhu sent the generals to see Diệm. The president listened to the group of seven, led by General Trần Văn Đôn. Đôn claimed that communists had infiltrated the monks at Xá Lợi Pagoda and warned that ARVN morale was deteriorating because of the civil unrest. He claimed that it was possible that the Buddhists could assemble a crowd to march on Gia Long Palace. Hearing this, Diệm agreed to declare martial law effective the next day, without consulting his cabinet. Troops were ordered into Saigon to occupy strategic points. Đôn was appointed as the acting Chief of the Armed Forces in the place of General Lê Văn Tỵ, who was abroad having medical treatment. Đôn noted that Diệm was apparently concerned with the welfare of the monks, telling the generals that he did not want any of them hurt. The martial law orders were authorized with the signature of Đôn, who had no idea that military action was to occur in the early hours of August 21 without his knowledge.

Shortly after midnight on August 21, on the instructions of Nhu, ARVN Special Forces troops under Colonel Lê Quang Tung executed a series of synchronized attacks on the Buddhist pagodas in South Vietnam. Over 1400 Buddhists were arrested. The number killed or "disappeared" is estimated to be in the hundreds. The most prominent of the pagodas raided was that of Xá Lợi, which had become the rallying point for Buddhists from the countryside. The troops vandalized the main altar and managed to confiscate the intact charred heart of Thích Quảng Đức, the monk who had self-immolated in protest against the policies of the regime. The Buddhists managed to escape with a receptacle holding the remainder of his ashes. Two monks jumped the back wall of the pagoda into the grounds of the adjoining US Aid Mission, where they were given asylum. Thich Tinh Khiet, the 80-year-old Buddhist patriarch, was seized and taken to a military hospital on the outskirts of Saigon. The commander of the ARVN III Corps, Tôn Thất Đính announced military control over Saigon, canceling all commercial flights into the city and instituting press censorship.

Once the US government realized the truth about who was behind the raids, they reacted with disapproval towards the Diệm regime. The US had pursued a policy of quietly and privately advising the Ngos to reconcile with the Buddhists while publicly supporting the alliance, but following the attacks, this route was regarded as untenable. Furthermore, the attacks were carried out by US-trained Special Forces personnel funded by the CIA, and presented incoming Ambassador Henry Cabot Lodge Jr., with a fait accompli. The state department issued a statement declaring that the raids were a "direct violation" of the promise to pursue "a policy of reconciliation".

On August 24, the Kennedy administration sent Cable 243 to Lodge at the embassy in Saigon, marking a change in US policy. The message advised Lodge to seek the removal of Nhu from power, and to look for alternative leadership options if Diem refused to heed American pressure for reform. As the probability of Diệm's sidelining Nhu and his wife was seen as virtually nil, the message effectively meant the fomenting of a coup. The Voice of America also broadcast a statement blaming Nhu for the raids and absolving the army of responsibility.

September 1963

After the events of August, Diệm's regime became a major preoccupation of the Kennedy administration and a fact-finding mission was launched. The stated purpose of the expedition was to investigate the progress of the war by South Vietnam and their US military advisers against the Viet Cong insurgency. The Krulak Mendenhall mission was led by Victor Krulak and Joseph Mendenhall. Krulak was a major general in the United States Marine Corps, while Mendenhall was a senior foreign service officer experienced in dealing with Vietnamese affairs. The trip lasted four days.

In their submissions to the United States National Security Council (NSC), Krulak presented an extremely optimistic report on the progress of the war, while Mendenhall presented a very bleak picture of military failure and public discontent. Krulak disregarded the effects of popular discontent in combating the Viet Cong. The general felt that the Vietnamese soldiers' efforts in the field would not be affected by the public's unease with Diệm's policies. Mendenhall focused on gauging the sentiment of urban-based Vietnamese and concluded that Diệm's policies increased the possibility of religious civil war. Mendenhall said that Diệm's policies were causing the South Vietnamese to believe that life under the Viet Cong would improve the quality of their lives.

The divergent reports led US President John F. Kennedy to famously ask his two advisers, "The two of you did visit the same country, didn't you?"

The inconclusive report was the subject of bitter and personal debate among Kennedy's senior advisers. Various courses of action towards Vietnam were discussed, such as fostering a regime change or taking a series of selective measures designed to cripple the influence of the Nhus, who were seen as the major causes of the political problems in South Vietnam.

The disparate reports of Krulak and Mendenhall resulted in a follow-up mission, the McNamara-Taylor mission.

November 1963

On November 1, 1963, after six months of tension and growing opposition to the regime, ARVN generals executed the 1963 South Vietnamese coup, which led to arrest and assassination of Ngô Đình Diệm.

Maternal-fetal conflict

From Wikipedia, the free encyclopedia

Maternal-fetal conflict, also known as obstetric conflict, occurs when a pregnant woman's (maternal) interests conflict with the interests of her baby (fetus). Legal and ethical considerations involving women's rights and the rights of the fetus as a patient and future child, have become more complicated with advances in medicine and technology. Maternal-fetal conflict can occur in situations where the mother denies health recommendations (e.g. blood transfusions, surgical procedures, cesarean section) that can benefit the fetus or make life choices (e.g. smoking, drinking alcohol, drugs, hazardous exposure) that can harm the fetus. There are maternal-fetal conflict situations where the law becomes involved, but most physicians avoid involving the law for various reasons.

Background

Prior to technological advances and current obstetric practices, the fetus was viewed as part of the mother and they were viewed as one entity rather than separate entities. With advances in technology, healthcare providers are able to access the fetus directly (e.g. sampling fetal blood, urine, other tissue, etc. and high-resolution ultrasonography) resulting in the fetus being defined as a separate patient from its mother. This shift from a perspective of 'unity' (referred to as the maternal-fetal dyad) to 'duality' of the mother and fetus has created a maternal-fetal conflict. With this shift, fetal interest has been taken into consideration separately from the mother's interest. Since the fetus can only be accessed through the mother, this change in perspective has become more complicated. In the perspective of the mother and fetus as one patient (a dyad), it is necessary to consider if the combined benefits of the mother and fetus outweigh the combined burdens. When making these decisions from the perspective of 'duality', it is necessary to determine the burdens and benefits of the mother and fetus separately.

Maternal rights

While a woman's right to privacy, right to autonomy, and informed consent are valued and prioritized during decision-making for the mother and fetus, there are various difficulties that arise with the perspective of the viability of a fetus, including "personhood". For example, the question of whether or not it is ethical to "gently persuade" a woman to make a decision she may not want to make because she is pregnant. In another example, a woman can receive a court-ordered cesarean section to save a fetus, but this is usually viewed as coercion, which is why most physicians avoid involving the court when helping make decisions for the mother and fetus.

Fetus

Fetus as a patient

There are many factors that define whether a fetus is a patient of its own or an entity involving its mother including: the fetus's independent moral status, the future fetus as a child, and the viability of the fetus. One view is that a fetus has rights when it has an independent moral status from its mother, but some ethicists cannot agree on when this occurs. A fetus has the right to become a child and the future of that child is taken into consideration when determining the independence of the fetus as a patient and in decision-making for the mother and fetus, (i.e. whether or not the health decisions will benefit the fetus when it becomes a child). A fetus has rights separate from its mother once the fetus is viable. Prior to viability of the fetus, the mother's autonomy and rights are prioritized.

Defining a healthy fetus

One perspective of decision making for maternal-fetal conflict is to prioritize the health of the mother and fetus, but it is difficult to determine what 'healthy' means for a fetus, especially without infringing on the basic rights of the mother. For those that define 'healthy' as 'perfect' or 'near-perfect' the implication is that a less than perfect fetus should not be born. Some of the people who are most opposed to prioritizing fetal rights are those with disabilities. The thought of a 'healthy' or 'perfect' child does not consider what a child with a disability would feel about how their mothers would be treated for choosing to bear them.

Maternal-fetal relationship

Experience, circumstance, and shared interest

With viewpoints shifting from the mother and fetus being a single unit to two individual units, understanding the mother's experiences and circumstances are necessary in decision-making. Not all women have direct control over their situation, which makes it difficult for a woman to make the best decision for their fetus. For example, a low-income mother may not be able to afford nutritious meals resulting in circumstance playing a role in maternal-fetal decisions. Instead of viewing the maternal-fetal relationship as a conflict, there are viewpoints that have shifted the perspective to maternal-fetal shared interest.

Protection of the fetus

There are different perspectives that value the protection of the fetus, but opposing viewpoints ask "what/whom is the fetus being protected from?" Most things a mother does can harm her fetus, even things that may not seem harmful (e.g. eating feta cheese or owning a cat). It is difficult to prove causality as development is multi-factorial, making it difficult to define what or who the fetus needs to be protected from. Although some may view the mother and fetus as separate entities, they are a unified dyad where the baby needs the mother to survive and their physiology is shared. This mentality allows decision-makers to best understand both patients's perspectives, and acknowledge the best interests for both the mother and their fetus.

Decision-making

The mother's autonomy and rights almost always are respected in decision-making. Decision-making is individualized based on prognosis, gestational age, and the pregnant woman's life and values. A variety of perspectives (e.g. pediatric, obstetric, etc.) are important to incorporate in decision-making process to best avoid being biased. Many ethicists have argued that women should have the same rights as non-pregnant women, which includes making decisions. It is also important to acknowledge that a mother generally will make the best decision for both herself and her fetus as she made the decision to have and continue the pregnancy. In cases where unwanted circumstances arise, it is difficult to blame a mother for uncontrollable, unfavorable fetal outcomes (e.g. birth defects) so giving the mother the benefit of the doubt is important. In order to make the best decisions for the mother and fetus, a physician-patient relationship is valuable as well as other maternal-fetal relationships (e.g. relationship to the father of the fetus, family members involved, etc.). Addressing the gestational age also affects decision making. Although, it's important to understand there is also very little information about early gestation periods, which makes it difficult to make decisions early on in the pregnancy.

Physician role

As an obstetrician and caregiver for the mother as a patient, it is important a physician acknowledges how their role and decisions affect both the mother and fetus, although the mother is ultimately their patient. Physicians must prioritize the mother's rights and autonomy as well as understand the value of beneficence and non-maleficence. Those that view the fetus and mother as one entity, acknowledge the overall benefit of a decision in regards to both the fetus and mother. Those that view the fetus and mother as separate entities, cannot overlook the mother's rights for the benefits of the fetus and vice versa. Other perspectives include overriding maternal autonomy if there is a more reliable option. For example, a cesarean section could save the baby and mother's life, but the mother wants a natural birth that will kill both entities so the mother's decision could be overruled. This is not always the case as there are other factors that are taken into consideration.

Mediating the conflict and honoring the patient

Physicians are not allowed to harm one patient for the benefit of another patient (i.e. a physician cannot harm a mother for the sake of the fetus and vice versa). If there is harm to one patient, that patient must volunteer to take treatment and not be influenced by the physician's bias. This causes difficulty as the fetus cannot voluntarily take a treatment and the fetus must be accessed through the mother. To avoid issues, physicians always prioritize the pregnant woman's autonomy as the physician's obligation is to the mother. The physician should refrain from unwanted procedures and treatments mentioned by the mother. It is important to establish that her autonomy cannot harm others. In the viewpoint of a maternal-fetal dyad, the mother is both a proxy for the best interest of the fetus and also separately the decision maker for herself as a patient. According to Susan Mattingly, a mother who denies treatment that benefits the fetus can no longer be an appropriate proxy for the fetus, but physicians still have to respect her as a separate patient with her own rights and autonomy. In the viewpoint of a maternal-fetal relationship being a one-patient model, a mother would only be harming herself if she denies treatment for fetus that may benefit fetus. These situations are normally avoided because punishment based on how a woman behaves in regards to her fetus could make women avoid medical care. The best way to establish a patient-physician relationship is by following best practices, conducting informed consent discussions, preparing for any situation that may arise, offering an alternate provider, compromise, providing documentation (e.g. medical record of information, treatment options, recommendations, etc.), and providing supportive resources for both the physician and provider, if problems are to arise.

Legal issues

Physicians are not required to obtain legal approval for decisions on mother and fetus, nor will a physician be in trouble with the law if they decide to make a decision on behalf of the mother and fetus. There are legal obstacles that make it difficult for the law to be involved in decision making for maternal-fetal conflict, which include the fetus having no rights, court standards being vague and flexible, discrimination towards disadvantage women, and the inability to force a woman to do things that are not required from anyone else (e.g. non-pregnant women, men, etc.). Lawmakers find it difficult to make exceptions to the law just because someone is pregnant (e.g. lawmakers find it difficult to forbid alcohol during pregnancy when non-pregnant women are permitted to drink alcohol). Allowing the fetus to have rights is difficult when it's dependent on a mother who has her own rights and autonomy. Even in the case where court-ordered cesarean sections seem necessary, most physicians and law-makers avoid it altogether as court-orders can be deemed as coercion. Women who have decisional capacity should be able to use it and refuse treatment if wanted. Because of these legal obstacles, law-makers and judges tend to prioritize women's rights to make their own decision.

Legal inequalities

The best interest of the fetus is established by the physician, but decided on by the mother. The problem is that there tends to be prejudices and inequalities when it comes to what is in the best interest of the fetus, especially in healthcare. According to Kelly Lindgren's journal, Maternal–Fetal Conflict: Court-Ordered Cesarean Section, “poor, minority women are affected most often by court-ordered c-section [...] which include: 47% Black Americans, 33% from Asia or Africa, and only 20% White.” It is also important to address that no other group of people are forced to do anything, so it is questioned why a woman who is pregnant should be forced. The court system is also reluctant to give the fetus and child the same rights. Women are burdened by laws resulting from their ability to be pregnant.

Legal case examples
Case name Summary
Roe v. Wade This United States Supreme Court decision ruled that it was unconstitutional to ban abortions as it goes against a woman's rights. It formulated the trimester framework: during the first trimester there can be no restrictions on abortions; during the second trimester there can be restrictions on abortions, but only for the sake of health and safety; and during the third trimester there are restrictions with exceptions
Planned Parenthood v. Casey This United States Supreme Court decision shifted away from the trimester framework as an undue burden
Prince v. Massachusetts This United States Supreme Court decision ruled that “Parents may be free to become martyrs themselves. But it does not follow that they are free, in identical circumstances, to make martyrs of their children”

Ethics

"Good ethics begins with good facts." An ethical framework (e.g. principle-based theories, conflict-based theories, feminist theory, and ethics of care) acknowledges the pregnant woman's competency to make her own decision for her and her body, including the fetus, but with the fetus’ well-being in mind. Acknowledging what happens after the fetus is delivered is the post-delivery perspective of pediatricians.

Principle-based and conflict-based theories

Principle-based theory is defined as "respect for patient autonomy, beneficence non-maleficence, and justice to guide conflict resolution." Conflict-based theories emphasize women's rights to autonomy and the physician's moral obligation to both the woman and the fetus separately. Conflict arises as pregnancy is only unique to women, which is why it is necessary to prioritize women's autonomy and rights. When the fetal interest is prioritized, it imposes on social and racial equality.

Feminist theory

Feminist theory (also known as feminist ethics) is a gender-based perspective, which acknowledges that women are treated differently in decision-making.

Ethics of care and relational ethics

Ethics of care and relational ethics acknowledges human relationships (i.e. relationship of patient to fetus, physician, community, society, etc.) as well as a woman's life experiences (e.g. age, political view, religion, lifestyle, etc.) and how that affects a person's decision-making. In terms of maternal-fetal conflict, it emphasizes understanding the patient's values and experiences to best support her decisions.

Sample of conflicting health problems affecting mother and fetus
Health problem Summary
Pre-eclampsia Pre-eclampsia is a pregnancy disorder where maternal hypertension and proteinuria can occur.
Cancer The most common types of cancers associated with pregnancies include malignant melanoma, lymphomas, and leukemia as well as cancer of the cervix, thyroid, ovary, breast, and colon. Maternal cancer therapy (e.g. chemotherapy, radiotherapy, or surgical oncology) tends to cause risks for fetus.
Immunological diseases The mother and fetus have their own individual immunological interfaces, which can cause immunological diseases.

The case of Medea

M. C. Reid's journal, "The case of Medea—a view of fetal-maternal conflict" alludes to the Greek Myth of Medea as it addresses maternal-fetal scenarios. The myth of Medea is about a woman named Medea who killed her two children as revenge against her husband. M. C. Reid compares Madea to several maternal-fetal scenarios, those of Meilssa, Nada, and Olga through the use of conflict analysis based on:

  1. the reason for the act.
  2. the life of the moral patients.
  3. the rights of the moral agent.

The reason for the act

There could be several reasons behind an act: is it inherently vicious (e.g. based on hatred, cruelty, greed, etc.); is it a morally commended act (e.g. based on respect, consideration, compassion, etc.); or is it a neutral act (e.g. based on no motives, accidental situations, etc.). Certain acts can seem good, but with vicious motives. For example, a surgeon does an intervention because they are sadistic, but the procedure helps the patient resulting in a good act, but with vicious intent. Reid argues that a mother would unlikely act purposely vicious toward her fetus.

The life of the moral patients

There are many different views of the maternal-fetal relationship:

  • One point of view addresses how the fetus affects the mother as they share a physiology, which is a counter-view to the fetus being separate from its mother.
  • Another perspective is the fetus being part of the mother as one unit, but the fetus gradually increases in moral value as a patient.
  • A third perspective is that the fetus is not of moral value until birth.

The rights of the moral agent

Women have rights and autonomy; some argue that these rights are under threat during situations involving abortion. As long as a woman is competent to make decisions regarding her own body and fetus, she is considered eligible to make decisions and retain her autonomy and rights.

Conflict analysis

The case of Medea uses conflict analysis to address and compare Medea's story to three other fictional women: Melissa, Nada, and Olga.

The case of Medea conflict analysis

Background story Reason for the act Life of the moral patient Rights of the moral participants
Medea As an act of revenge against her husband, Madea killed her two children. While clear and understandable, the act as not justifiable. Considering the status of a woman in Greece in Medea's era, where she sacrificed a lot for her husband, this act was a way for her to reclaim her personhood. The children are innocent, yet their mother killed them.
Melissa Melissa is 30 weeks pregnant with twins, and wants to terminate her pregnancy The justification is similar to Medea's situation. Denying termination of the pregnancy means denying Melissa's rights. The difference between Melissa's situation and that of Medea's is that the fetal twins have different moral value than born children, but there is no justification for the termination other than Melissa not wanting to continue the pregnancy.
Nada Nada, at 24 weeks of pregnancy has HTN-of-pregnancy (HOP) syndrome, where there is a risk of brain hemorrhage and seizures to the mother. She has to terminate the pregnancy to save her life, but is upset about it. In order to save the life of the mother, the termination is justifiable. No one is expected to sacrifice one's own life for another. Based on the gradualist point of view, the moral status of the fetus is less in value at early gestational age.
Olga At 22 weeks of pregnancy, Olga has mixed feelings, but no strong dislike for the fetus. She prefers to not go through with pregnancy because she believes the pregnancy is becoming a burden. While there is no absolute wrong in this situation, it cannot be quite justifiable. Denying termination of the pregnancy means denying Olga's rights. This is a very nebulous situation because if the fetus is a burden, but not a health problem, it is necessary to weigh the needs of the fetus and mother.

 

Paradise

From Wikipedia, the free encyclopedia

Paradise by Jan Bruegel

In religion, paradise is a place of exceptional happiness and delight. Paradisiacal notions are often laden with pastoral imagery, and may be cosmogonical or eschatological or both, often compared to the miseries of human civilization: in paradise there is only peace, prosperity, and happiness. Paradise is a place of contentment, a land of luxury and fulfillment. Paradise is often described as a "higher place", the holiest place, in contrast to this world, or underworlds such as Hell.

In eschatological contexts, paradise is imagined as an abode of the virtuous dead. In Christian and Islamic understanding, Heaven is a paradisiacal relief. In old Egyptian beliefs, the otherworld is Aaru, the reed-fields of ideal hunting and fishing grounds where the dead lived after judgment. For the Celts, it was the Fortunate Isle of Mag Mell. For the classical Greeks, the Elysian fields was a paradisiacal land of plenty where the heroic and righteous dead hoped to spend eternity. In Buddhism, paradise and the heaven are synonymous, with higher levels available to beings who have achieved special attainments of virtue and meditation. In the Zoroastrian Avesta, the "Best Existence" and the "House of Song" are places of the righteous dead. On the other hand, in cosmogonical contexts 'paradise' describes the world before it was tainted by evil.

The concept is a theme in art and literature, particularly of the pre-Enlightenment era, a well-known representative of which is John Milton's Paradise Lost.

Etymology and concept history

The luxurious palace and gardens of Neo-Assyrian king Ashurbanipal (ruled 668-631 BCE) at Nineveh, with original color reconstitution. Irrigation canals radiate from an aqueduct. The king appears under the porch. British Museum.

The word "paradise" entered English from the French paradis, inherited from the Latin paradisus, from Greek parádeisos (παράδεισος), from an Old Iranian form, from Proto-Iranian*parādaiĵah- "walled enclosure", whence Old Persian 𐎱𐎼𐎭𐎹𐎭𐎠𐎶 p-r-d-y-d-a-m /paridaidam/, Avestan 𐬞𐬀𐬌𐬭𐬌⸱𐬛𐬀𐬉𐬰𐬀 pairi-daêza-. The literal meaning of this Eastern Old Iranian language word is "walled (enclosure)", from pairi- 'around' (cognate with Greek περί, English peri- of identical meaning) and -diz "to make, form (a wall), build" (cognate with Greek τεῖχος 'wall'). The word's etymology is ultimately derived from a PIE root *dheigʷ "to stick and set up (a wall)", and *per "around".

By the 6th/5th century BCE, the Old Iranian word had been borrowed into Assyrian pardesu "domain". It subsequently came to indicate the expansive walled gardens of the First Persian Empire, and was subsequently borrowed into Greek as παράδεισος parádeisos "park for animals" in the Anabasis of the early 4th century BCE Athenian Xenophon, Aramaic as pardaysa "royal park", and Hebrew as פַּרְדֵּס pardes, "orchard" (appearing thrice in the Tanakh; in the Song of Solomon (Song of Songs 4:13), Ecclesiastes (Ecclesiastes 2:5) and Nehemiah (Nehemiah 2:8)). In the Septuagint (3rd–1st centuries BCE), Greek παράδεισος parádeisos was used to translate both Hebrew פרדס pardes and Hebrew גן gan, "garden" (e.g. (Genesis 2:8, Ezekiel 28:13): it is from this usage that the use of "paradise" to refer to the Garden of Eden derives. The same usage also appears in Arabic and in the Quran as firdaws فردوس.

The idea of a walled enclosure was not preserved in most Iranian usage, and generally came to refer to a plantation or other cultivated area, not necessarily walled. For example, the Old Iranian word survives as Pardis in New Persian as well as its derivative pālīz (or "jālīz"), which denotes a vegetable patch.

Biblical

Hebrew Bible

Nicolas Poussin, Four seasons of paradise, 1660–1664

The word pardes does not appear before the post-Exilic period (post-538 BCE); it occurs in the Song of Songs 4:13, Ecclesiastes 2:5, and Nehemiah 2:8, in each case meaning "park" or "garden", the original Persian meaning of the word, where it describes to the royal parks of Cyrus the Great by Xenophon in Anabasis.

Later in Second Temple era Judaism "paradise" came to be associated with the Garden of Eden and prophesies of restoration of Eden, and transferred to heaven. The Septuagint uses the word around 30 times, both of Eden, (Gen. 2:7 etc.) and of Eden restored (Ezek. 28:13, 36:35 etc.). In the Apocalypse of Moses, Adam and Eve are expelled from paradise (instead of Eden) after having been tricked by the serpent. Later after the death of Adam, the Archangel Michael carries the body of Adam to be buried in Paradise, which is in the Third Heaven.

New Testament

The New Testament use and understanding of paradise parallels that of contemporary Judaism. The word is used three times in the New Testament writings:

  • Luke 23:43 – by Jesus on the cross, in response to the thief's request that Jesus remember him when he came into his kingdom.
  • 2 Cor.12:4 – in Paul's description of a man's description of a third heaven paradise, which may in fact be a vision Paul himself saw.
  • Rev.2:7 – in a reference to the Gen.2:8 paradise and the tree of life

Judaism

According to Jewish eschatology, the higher Gan Eden is called the "Garden of Righteousness". It has been created since the beginning of the world, and will appear gloriously at the end of time. The righteous dwelling there will enjoy the sight of the heavenly chayot carrying the throne of God. Each of the righteous will walk with God, who will lead them in a dance. Its Jewish and non-Jewish inhabitants are "clothed with garments of light and eternal life, and eat of the tree of life" (Enoch 58,3) near to God and His anointed ones. This Jewish rabbinical concept of a higher Gan Eden is opposed by the Hebrew terms gehinnom and sheol, figurative names for the place of spiritual purification for the wicked dead in Judaism, a place envisioned as being at the greatest possible distance from heaven.

Rabbinic Judaism

In modern Jewish eschatology it is believed that history will complete itself and the ultimate destination will be when all mankind returns to the Garden of Eden.

In the Talmud and the Jewish Kabbalah, the scholars agree that there are two types of spiritual places called "Garden in Eden". The first is rather terrestrial, of abundant fertility and luxuriant vegetation, known as the "lower Gan Eden". The second is envisioned as being celestial, the habitation of righteous, Jewish and non-Jewish, immortal souls, known as the "higher Gan Eden". The rabbis differentiate between Gan and Eden. Adam is said to have dwelt only in the Gan, whereas Eden is said never to be witnessed by any mortal eye. In Rabbinic Judaism, the word 'Pardes' recurs, but less often in the Second Temple context of Eden or restored Eden. A well-known reference is in the Pardes story, where the word may allude to mystic philosophy.

The Zohar gives the word a mystical interpretation, and associates it with the four kinds of Biblical exegesis: peshat (literal meaning), remez (allusion), derash (anagogical), and sod (mystic). The initial letters of those four words then form פַּרְדֵּסp(a)rd(e)s, which was in turn felt to represent the fourfold interpretation of the Torah (in which sod – the mystical interpretation – ranks highest).

Christianity

Mead Bradock, Paradise According to Three Different Hypotheses, 1747
 

In the 2nd century AD, Irenaeus distinguished paradise from heaven. In Against Heresies, he wrote that only those deemed worthy would inherit a home in heaven, while others would enjoy paradise, and the rest live in the restored Jerusalem (which was mostly a ruin after the Jewish–Roman wars but was rebuilt beginning with Constantine the Great in the 4th century). Origen likewise distinguished paradise from heaven, describing paradise as the earthly "school" for souls of the righteous dead, preparing them for their ascent through the celestial spheres to heaven.

Many early Christians identified Abraham's bosom with paradise, where the souls of the righteous go until the resurrection of the dead; others were inconsistent in their identification of paradise, such as St. Augustine, whose views varied.

In Luke 23:43, Jesus has a conversation with one of those crucified with him, who asks, “Jesus, remember me when you come into your kingdom". Jesus answers him, “Truly I tell you, today you will be with me in paradise”. This has often been interpreted to mean that on that same day the thief and Jesus would enter the intermediate resting place of the dead who were waiting for the Resurrection. Divergent views on paradise, and when one enters it, may have been responsible for a punctuation difference in Luke; for example, the two early Syriac versions translate Luke 23:43 differently. The Curetonian Gospels read "Today I tell you that you will be with me in paradise", whereas the Sinaitic Palimpsest reads "I tell you, today you will be with me in paradise". Likewise the two earliest Greek codices with punctuation disagree: Codex Vaticanus has a pause mark (a single dot on the baseline) in the original ink equidistant between 'today' and the following word (with no later corrections and no dot before "today"), whereas Codex Alexandrinus has the "today in paradise" reading. In addition, an adverb of time is never used in the nearly 100 other places in the Gospels where Jesus uses the phrase, "Truly I say to you".

In Christian art, Fra Angelico's Last Judgement painting shows Paradise on its left side. There is a tree of life (and another tree) and a circle dance of liberated souls. In the middle is a hole. In Muslim art it similarly indicates the presence of the Prophet or divine beings. It visually says, "Those here cannot be depicted".

Jehovah's Witnesses

Jehovah's Witnesses believe, from their interpretation of the Book of Genesis, that God's original purpose was, and is, to have the earth filled with the offspring of Adam and Eve as caretakers of a global paradise. However, Adam and Eve rebelled against God's sovereignty and were banished from the Garden of Eden, driven out of paradise into toil and misery.

Jehovah's Witnesses believe that disobedient and wicked people will be destroyed by Christ at Armageddon and those obedient to Christ will live eternally in a restored earthly paradise. Joining the survivors will be the resurrected righteous and unrighteous people who died prior to Armageddon. The latter are brought back because they paid for their sins by their death and/or because they lacked opportunity to learn of Jehovah's requirements before dying. These will be judged on the basis of their post-resurrection obedience to instructions revealed in new "scrolls". They believe that resurrection of the dead to paradise earth is made possible by Christ's blood and the ransom sacrifice. This provision does not apply to those whom Christ as Judge deems to have sinned against God's holy spirit.

One of Jesus' statements before he died were the words to a man hanging alongside him, "you will be with me in Paradise."[Luke 23:43] The New World Translation places a comma after the word 'today', dividing it into two separate phrases, "I tell you today" and "you will be with me in Paradise". This differs from standard translations of this verse as "I tell you today you will be with me in Paradise". Based on scriptures such as Matthew 12:40, 27:63, Mark 8:31 and 9:31, Witnesses believe Jesus' expectation that he would be bodily resurrected after three days precluded his being in paradise on the same day that he died.

Mormonism

In Latter Day Saint theology, paradise usually refers to the spirit world, the place where spirits dwell following death and awaiting the resurrection. In that context, "paradise" is the state of the righteous after death. In contrast, the wicked and those who have not yet learned the gospel of Jesus Christ await the resurrection in spirit prison. After the universal resurrection, all persons will be assigned to a particular kingdom or degree of glory. This may also be termed "paradise".

Islam

In the Quran, Heaven is denoted as Jannah (garden), with the highest level being called Firdaus, i.e. Paradise. It is used instead of Heaven to describe the ultimate pleasurable place after death, accessible by those who pray, donate to charity, read the Quran, believe in: God, the angels, his revealed books, his prophets and messengers, the Day of Judgement and the afterlife, and follow God's will in their life. Heaven in Islam is used to describe skies in the literal sense and metaphorically to refer to the universe. In Islam, the bounties and beauty of Heaven are immense, so much so that they are beyond the abilities of mankind's worldly mind to comprehend. There are eight doors of Jannah. These are eight grades of Jannah:

  • 1. Jannah al-Mawa
  • 2. Dar al-Maqam
  • 3. Dar al-Salam
  • 4. Dar al-Khuld
  • 5. Jannah al-Adn
  • 6. Jannah al-Na'im
  • 7. Jannah al-Kasif
  • 8. Jannah al-Firdaus

Jannah al-Mawa is in the lowest, Jannah al-Adn is the middle and Jannah al-Firdaus is the highest.

Imam Bukhari has also recorded the tradition in which the Prophet said,

'When you ask from Allah, ask Him for Al-Firdaus, for it is the middle of Paradise and it is the highest place and from it the rivers of Paradise flow.' (Bukhari, Ahmad, Baihaqi)

In this tradition, it is evident that Al-Firdaus is the highest place in Paradise, yet, it is stated that it is in the middle. While giving an explanation of this description of Al-Firdaus, the great scholar, Ibn Hibban states,

'Al-Firdaus being in the middle of Paradise means that with respect to the width and breadth of Paradise, Al-Firdaus is in the middle. And with respect to being 'the highest place in Paradise', it refers to it being on a height.'

This explanation is in agreement to the explanation which has been given by Abu Hurairah (r.a.) who said that

'Al Firdaus is a mountain in Paradise from which the rivers flow.' (Tafseer Al Qurtubi Vol. 12 pg. 100)

The Quran also gave a warning that not all Muslims or even the believers will assuredly be permitted to enter Jannah except those who had struggled in the name of God and tested from God's trials as faced by the messengers of God or ancient prophets:

Or do you think that you will enter Paradise while such [trial] has not yet come to you as came to those who passed on before you? They were touched by poverty and hardship and were shaken until [even their] messenger and those who believed with him said,"When is the help of Allah ?" Unquestionably, the help of Allah is near.
Qur'an 2:214 (Al-Baqarah) (Saheeh International)

Gnosticism

On the Origin of the World, a text from the Nag Hammadi library held in ancient Gnosticism, describes Paradise as being located outside the circuit of the Sun and Moon in the luxuriant Earth east in the midst of stones. The Tree of Life, which will provide for the souls of saints after they come out of their corrupted bodies, is located in the north of Paradise besides the Tree of Knowledge that contains the power of God.

Copper

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