Right Livelihood

When I was asked several years ago to write a personal perspective on my career as a doctor in relation to right livelihood, I thought it would be easy. It is a huge privilege to work as a doctor with a livelihood dedicated to alleviating the effects of illness – we try and help people when they are vulnerable and are often admitted to their most private life events. The most useful advice I received is that a good doctor should “cure sometimes, relieve often and comfort always”. Medical graduates in the UK no longer swear a Hippocratic oath but are still bound by its main principles to treat the sick, to preserve patients’ secrets, to respect teachings and above all, to do no harm. These obligations are taught from an early stage and form part of the compact between medicine and society which is why self-regulation of the profession is taken so seriously by the General Medical Council. Under these circumstances, the matter of right livelihood might seem self-evident. However, the more I thought about this, the more I realized I didn’t really know the answer or understand how much the self is separate from professional identity.

Right livelihood is a moral judgment on how we earn a living. It comes under the teachings about personal discipline as part of the Buddha’s eight-fold path, along with right speech and right actions. Livelihood is simply a means of earning a living and it’s only one aspect of the tapestry of life. We could just as easily talk about right relationships, right financial dealings, or right interests and hobbies. Conceptsof right and wrong are human creations, and become hazy once we start to consider interconnectedness. They have no validity in ultimate reality. Morality, if it can be defined at all outside the duality of human existence, seems to be as much about intention as effect. It seems that the livelihood aspect of right living is just an external shell and that within that are all sorts of self-oriented actions that may or may not be defined as right.

Zen master Ikkyu once visited a rich person’s house dressed in his usual monk’s gown to ask for food. He was turned away. Subsequently he visited the same house clad in his abbot’s robe and was offered a sumptuous meal. He refused to eat the feast. He took off his robe and placed it before the food stating that the food belonged to the robe and not to him. Are all those who claim right livelihood just wearing the correct robes?

Choosing to become a doctor might be seen as an early step towards right livelihood but was not really a choice for me at all. Experience of childhood illness and seeing the power wielded by doctors and the respect that my mother gave them made me want to become a member of that important group, not to mention enjoying the encouragement and approval from my grandparents. Seeking power and approval, even in a young child, is not a particularly promising start for a career in right livelihood.

The choices we make in life, even though seemingly innocent and altruistic, are often underpinned by self-interest. For example, in my early career I had been fortunate to obtain a training place at a prestigious institution, and was therefore in a strong position to join a general practice in any part of the country. However, I did not apply for a partnership in a deprived area where health needs are greatest and doctors in short supply. Instead, I chose an established practice in an affluent seaside town with a good quality of life. By some right livelihood standards, that qualifies as a fail. However, we have to consider the duality of living in this world and take into account considerations of social and family relationships, schools and housing.

Even if all appears to be going well, there are many pitfalls in just unthinkingly accepting that certain careers are automatically better than others in terms of right livelihood. There is no immunity for doctors from ordinary workplace vexations such as greed, envy, anger or irritation. When does ambition become wrong? Asking for a pay rise or a budget increase is not intrinsically bad, but undermining others in order to obtain it would be. Helping others by exercising professional skills and knowledge is a power relationship, which can easily be abused. The gratification from helping others can become so intoxicating that wisdom and compassion disappear. The fifth bodhisattva precept to avoid intoxicants does not apply just to alcohol or drugs but to anything that is so addictive that the self loses mindfulness. It is a very slippery path.

Even mindful medical practice can throw out ethical dilemmas that some may consider wrong. Therapeutic abortion for example is highly controversial and doctors have to balance the consequences of a number of different actions. When faced with a choice, harms and benefits can accrue as much from not doing something as from doing it, and either way could be construed as part of wrong livelihood. During the recent pandemic, there has been an enormous increase in non-recyclable hygiene items sent to landfill. We all know about our responsibilities to minimize waste of resources but single use plastics and other items have an important role in reducing cross infection. Who will judge the rightness of all of this?

Actions that directly harm others generally fall into the category of being wrong but even that is not straightforward. The avoidance of killing is generally taken to proscribe eating meat but the growth of crops has had huge deleterious effects on the diversity of the environment and on wildlife. I’m not criticizing vegetarian lifestyles – just illustrating that even apparently acceptable activities cannot avoid causing harm. Looking at the other side of the argument about what might constitute wrong livelihood, I can see very little upside to a way of life that involves profiting from addiction. Even so, we might feel confident in criticizing a cocaine cartel boss but how would we categorize an impoverished Afghan opium farmer keeping their family fed?

I have to conclude that there is no such thing as right livelihood. How we earn a living is simply just one aspect of the fabric of our lives. Some of us are fortunate in that events outside our control such as parental influences and schooling opportunities have made things much easier, but ultimately it’s all about following the chosen path mindfully – and trying to minimize and learn from our mistakes along the way. Just putting one foot in front of the other seems to be sufficient.