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In recent years, efforts to instill ethical standards—character education, values training—have gained momentum.

From schoolyard prayer rallies to congressional support for posting the Ten Commandments in public places, many voices are calling for a renewed infusion of traditional Judeo-Christian morality into civic institutions. Others, sensitive to America's increasing religious diversity, favor promoting ethical standards that are either secular or pluralistic in their use of faith traditions.

Health care institutions have also found themselves involved in this debate, as they re-evaluate their ethical and religious foundations in the face of sweeping social forces transforming the industry. For some, posting (or re-posting) the Ten Commandments on the walls of health care facilities symbolizes the spirituality of the nursing or medical vocation.

Just as in the more public debate, others wish to explore a broadly based ethical foundation. Toward that end, and in recognition of the increasing influence of Asian religions, it might prove fruitful to look at what Buddhist thought can contribute to the debate over teaching values in large, diverse institutions. How, for instance, would posting the Five Precepts, Buddhism's ethical touchstone, help improve the health of America's health care institutions? One interesting aspect of Buddhism is that it offers a religious ethic without a divine imperative, an intriguing perspective that differs from the usual spiritual/secular dichotomy that hamstrings so much of this debate. The Five Precepts themselves offer a rich example of this perspective.

First Precept: not to destroy living beings. The negative phrasing of the Buddhist precepts is noteworthy. "Thou shalt not" is fundamental religious terminology, as religions make a strong case that society cannot tolerate certain behavior if it is to function well and nurture the good life for its members. The First Precept of Buddhism clearly goes beyond the limited proscription of the biblical commandment, which singles out murder of human beings. Thus Buddhism tends toward vegetarianism, though most Buddhists do not live up to this ideal (as the menu at the nearest Thai restaurant will indicate). Still, the ideal remains.

Like most negative religious commands, the First Precept also lends itself to a positive reading, illustrated for me some years ago when I happened upon a Buddhist monk in a local immigrant temple. He was dropping bits of bread into a large jar, in the bottom of which I saw a bed of grass. I asked him what he was doing. "I'm nursing this poor creature back to health," he answered. I looked closely and saw a shivering, emaciated mouse. "We found this mouse in the head monk's bed, where it crawled to die. I'm feeding it so it will live." Thus, the positive interpretation of the First Precept encourages compassion and kindness to all living beings.

I wonder—how do hospitals deal with mice on the premises? I'm pretty sure they don't nurture their health. But Buddhism believes in the interdependence of all living things, so that callous disregard for animal life is connected to attitudes toward human beings. When Buddhists exterminate dangerous pests, they do so with remorse for the life taken. As to the mice in that local temple, the head monk's solution was to say, "We should get a cat." Apparently cats are not bound by the Five Precepts.

As Buddhist ethicist Damien Keown explains, classical Buddhist interpretations of the First Precept offer insights onto modern medical debates. Referring to a fifth century commentator, Keown remarks that "some of what he says would not be out of place in a professional code of ethics such as that of the AMA." For instance, the commentaries and the primary texts behind them prohibit assisted suicide or even encouragement of suicide, though they do not condone prolonging life at all costs.

Second Precept: not to steal. This rings a bell, given the biblical injunction to the same effect. Of course, stealing is a problem in all organizations, including health care institutions, from pilfering paper clips to misappropriating funds. In its literal rendition, recited by Buddhist children from the time they can speak, the Second Precept sheds an interesting light on the nature of theft: "I take upon myself the precept of abstention from taking that which is not given." If someone does not give you something, it is not yours to take. My daughter learns this lesson every time she brings home something she has found. "Who gave that to you?" I ask. She knows that without permission, taking is stealing. Health care providers and medical researchers might consider the implications here for informed consent of patients and subjects: a person owns their consent, which should not be stolen any more than their money. Buddhist scholar Peter Harvey points out that Buddhism absolves one who takes something without knowing that it belongs to another. Such an excuse hardly applies to stealing consent from a patient or subject.

The positive counterpart to the Second Precept is the Buddhist virtue of generosity. To give is a greatly meritorious act. In many local Buddhist temples, for instance, nurses' associations organize charitable drives for their members during major religious holidays. How does charity figure in to American health care today?

Third Precept: perhaps this precept should be posted in its original language because of the sensitivity of the subject: Kamesu micchacara veramani sikkhapadam samadiyami. Sexuality is a matter of both concern and contention in the public realm, ranging from STDs to First Amendment rights of expression. So I guess this precept needs to appear in English to make an impact: "I take upon myself the precept of abstention from sexual misconduct." For adolescent and other unmarried Buddhists in this country, the precept advocates the virtue of contentment in sexual abstinence—not safe sex behavior; for spouses, the precept calls for marital fidelity. The sexual health of everyone is thus guarded.

One more point about the Third Precept. Although most Buddhists are not celibates, they generally recognize celibate monasticism as an ideal lifestyle, in which monks and nuns renounce all sexual conduct as impediment to living a spiritual life. Any sexual conduct by Buddhist monastics is considered misconduct. How would that play in America, where so many people seem to think sex is a human necessity like food and water, as one Buddhist monk observed to me? (Try an experiment sometime: go without sex for six months and you'll probably live, but try it without food and water and see how long you last). The Buddhist ideal does offer an alternative to obsession with sexuality—drop it altogether.

Fourth Precept: not to tell falsehoods. Buddhists understand the negative consequences of boldfaced lying, but this precept also covers gossip and other forms of unproductive and hurtful speech. Holding tongues in check could only improve the atmosphere wherever people spend their day together.

Positively speaking—literally—this precept calls Buddhists to a love of truth and clarity in thought and expression. To be sure, telling the truth about a patient's condition is a primary value in health care, but it sometimes conflicts with other important values, like confidentiality or cultural preferences in handling health crises. In some cultures, the individual's right to the truth is contingent upon the impact of its disclosure on the general well-being of the family. A recent survey found that a significant number of physicians approved of lying to an HMO or insurance company about a patient's condition if there was no other way to secure necessary treatment. Such ethical complexities call for the clear articulation and consistent implementation of the values underlying the health care profession.

Fifth Precept: here the Buddhist precepts offer thought-provoking insight with no direct analogue in the biblical Decalogue. In long form the Fifth Precept reads: "I take upon myself the precept of abstention from taking any intoxicating drinks that give rise to carelessness." The prohibition has been extended to all intoxicants, including modern addictive drugs. A Buddhist monk once told me that the Fifth Precept is primary because of its potential comprehensiveness: break it, he warned, and the resulting carelessness easily leads to transgression of the other four. Any emergency room nurse can attest to the high percentage of patients admitted due to intoxication-related circumstances, from domestic abuse and other physical altercations, to drunk driving and drug overdoses. In a way, the "Just Say No" campaign in the schools is quintessentially Buddhist. In positive terms, the precept points up the virtue of a unclouded, disciplined, and wise mind.

"The Ten Commandments need to be in the schools," said one supporter of a recent campaign to distribute school bookcovers emblazoned with the Decalogue, "and we have to get them there." I haven't heard Buddhists in this country advocating that the Five Precepts need to be in our public institutions, though posting them side-by-side with the Ten Commandments might generate an enlightening comparative discussion about the spiritual foundations of ethics in the public realm, particularly in the health care sector.

The rub for many might be the fact that Buddhism lacks the notion of an almighty, creator God who is the source of human ethics. There is no prologue to the precepts as there is to the commandments: "I am the LORD your God." According to the Buddha, ethical values undergird spiritual living, but without reference to a God. For some this might lead to reflection on universal concerns about compassion toward all life, theft and generosity, sexual conduct, truth, and mental clarity. Damien Keown notes that Buddhists "are rarely found at the cutting edge of modern ethical debates." Perhaps that should change.

For more about Buddhist ethics, consult the on-line Journal of Buddhist Ethics at http://jbe.la.psu.edu.