There are many aspects involved in preparing for the end of life. For Jains, it may include Sallekhanā, a voluntary and gradual reduction of food (and eventually water) until the individual fasts to death.
Originating in the Ganges basin of eastern India between the 7th–5th century BC, Jainism is often described as a cousin to Hinduism and Buddhism. Karma is a central tenet and asceticism and forgiveness are emphasized. Jains believe in reincarnation and that all beings have souls, and as a result, they are strict vegetarians. Nonviolence is a fundamental component of the religion and it is said Mahatma Gandhi was influenced by Jainism in his youth.
The Jain belief that nearly everything--even plants--has a soul and their adherence to nonviolence factors into their taking the vow of Sallekhanā, explains Dr. Whitny Braun, a bioethicist at Claremont Lincoln University. She has spent nine years researching Jainism and a book based off her dissertation on the subject is anticipated to be published in 2016. According to Braun, “Philosophically and logistically in life, the only way to be completely nonviolent is to stop taking other lifeforms and the only way to completely stop taking life forms is to not consume them. So for Jains, the ultimate way to exit this life is to stop eating, to stop taking those lifeforms.”
The decision to take Sallekhanā is made once a person feels their life has served its purpose. Not all Jains opt to take Sallekhanā but, if they choose to, they consult with a monk who provides spiritual guidance. There are rare instances where the monk may not believe it is the appropriate time to begin the vow of Sallekhanā but, if there is a consensus, the process is ideally a gradual one, taking twelve years, with shorter versions for certain circumstances. In their remaining time, the person makes a conscious effort to make amends, asks for forgiveness, and slowly consumes less food and liquids until death--an end that ultimately occurs due to renal failure.
The process of Sallekhanā contrasts with how deaths typically occur in the United States, where end of life is associated with high costs. The concept of death is also departure from those typically seen in the West--while no one looks forward to passing, Braun explains the Jain perspective differs from Judeo-Christian beliefs since life is seen as cyclical. She also emphasizes the need for closure to occur prior to passing.
“Their cultural understanding is you have to leave when the time comes. On one hand, I thought that would be very painful but on the other hand, it’s not that dramatic clinging to life end that I’ve seen so many times in the hospital where people are saying things to each other that they should have said five, fifteen, twenty years ago. You’re not saying that in the last five minutes of your life when you’re hooked up to a morphine drip.”
The death is intended to be peaceful and is sometimes described as euphoric. While Jains may attribute the euphoria to a spiritual experience, from a medical perspective, when foods and liquids are withheld, the body enters a state of ketosis. In its advanced stages, ketosis can sometimes produce feelings of serenity and mild euphoria, and studies have indicated minimal pain may be experienced during the process.
A serene death through Sallekhanā isn’t always the case, and sometimes science and religion can be at odds. The practice has caused controversy in the past for this reason. One of the most known examples of Sallekhanā involved a 24 year old Jain nun in Ladnun, India who was believed to have been tormented by past lover’s bhut (spirit) from a previous life. Because of the voices she heard, she could not do her meditations, read scriptures, do prayers, or any of the prescribed acts which are necessary to be a good nun. Consequently, it was viewed that she was unable to grow spiritually and she took a vow of Sallekhanā, passing 54 days later.
The body of a physically healthy 24 year old reacts differently to abstaining from food and water than an elderly hospice patient who may die in the same manner, notes Braun. These factors led Braun to believe her death was unpleasant, and she also speculated that the nun may have been schizophrenic. “There’s a part of me that wants to ask why couldn’t we have gotten her help but, in the Jain sense, this is but one life of many and it was better that she just wrapped this one up quickly and moved on and had peace.”
“The crux of it,” asks Braun, “is how do you hold onto your old gods, if you will, in an era dominated by science and technology?”
The nun in Ladnun represents a more extreme example of Jainism and the vow of Sallekhanā. There are four million Jains worldwide with varying levels of adherence to their religion, ranging from the most strict ascetic monks and nuns to members of the laity, known as householders. Although all Jains adhere to the same basic rules, monks and nuns are expected to live more austere lives than householders, who are often affluent and prominent within their communities.
Over the last few decades, there has been an increase in the number of Jains living abroad--an estimated 100,000 live outside India. As they move to large cities within India and throughout the world, their environments have influenced the way they interpret Jainism and how they reconcile science and religion. Braun documented one of the first people to undertake Sallekhanā in the United States, chronicling her decision and final days.
Dr. Bhagwati Gada and her husband, both physicians, emigrated from India to Texas in the 1970s. Initially, Gada had chemotherapy and radiation to combat her colon cancer. Although Jains view nearly everything--including bacteria--to have souls, she made an exception with cancer cells since they were dependent on her body for growth. Once her cancer progressed to Stage 4, Gada felt she had gotten all she could from her body and took a shorter vow of Sallekhanā. Deviating from the tradition of cremation, she opted to have her body donated to science. If her body was only a vessel for her soul, Gada thought it could be more effectively used following her passing since the bulk of cancer research done in the United States is done on a Caucasian population.
“One thing you will find amongst Jains universally is that Sallekhanā is abstaining from food and water and that it is a very conscious decision,” says Braun. She explains that the ideal version of taking the vow could have occurred when the religion originated--an individual could have slipped into the woods to complete Sallekhanā. Despite there being a universal consensus on what it is overall, there are issues to consider now that weren't there when the religion began and Braun notes that there can be dissent within the Jain community, and even within a family, as to what constitutes Sallekhanā.
Since Sallekhanā is intended to be a quiet, peaceful transition, Gada’s family did not anticipate the pain she would experience towards the end of her life. Although it hadn’t been discussed, her children, who are also physicians, had Gada on a morphine drip to alleviate some of her pain. Even though she had no food or water at the end of her life, Gada’s husband believed she didn’t technically take a vow of Sallekhanā since she received morphine. Her children disagreed, seeing the morphine as facilitating the peacefulness meant to accompany Sallekhanā.
In the Jain religion, suicide is seen as an act of violence against oneself and is strictly forbidden. However, Sallekhanā has been in the news recently, as a case in India is set to determine whether it is protected under the Indian constitution’s religious freedom legislation or if it is punishable under section 309 of the Indian Penal Code, which criminalizes attempts at suicide. The case, which uses portions of Braun’s dissertation, is expected to take three to five years before there is an official ruling from the Supreme Court.