The macroscopic quantum tunneling in a double-well potential with dissipation is formulated without referring to instantons. This formulation, in the domain of small dissipation, goes beyond the instanton approximation which corresponds to the two-state truncated system (or, the so-called spin-boson Hamiltonian). It is first confirmed that our formulation, when applied to the two-state truncated system, reproduces all the known results of the instanton approximation. It is then shown that the ground state is mixed with excited states by dissipative interactions and this effect tends to enhance the ground-state quantum tunneling. In the Ohmic dissipation case this enhancement factor, even for a shallow double-well potential, can be at most comparable to the suppression factor which has been known from the work by Caldeira and Leggett. In the super-Ohmic case, however, the enhancement factor generally exceeds the suppression factor and the two-state approximation fails. A salient feature in the choice of counter terms in macroscopic quantum tunneling, which is essential to the above conclusion, is emphasized.