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1 Health Law / Medical Ethics SALLEKHANA Health Law / Medical Ethics SALLEKHANA: THE ETHICALITY AND LEGALITY OF RELIGIOUS SUICIDE BY STARVATION IN THE JAIN RELIGIOUS COMMUNITY Whitny Braun∗ Abstract: This article examines Sallekhana, the Jain religious ritual of fasting to death, from the American and Indian legal and ethical perspectives. Two cases are presented, the first involving a woman in her twenties who ritually starved herself to death to escape the torment of a voice in her head and the second case involving a woman in her sixties diagnosed with terminal cancer of the brain and liver who chose to starve to death rather than accept palliative care. Both cases of Sallekhana are analyzed with attention paid to the Jain theological rationale behind the practice and the social circumstances that predicate this vow of starvation. I argue that within Jain communities the moral presumption should be that Sallekhana is a valid religious ritual of dying and therefore should be legally protected, if and only if, it is freely chosen by an informed person free from coercion. Keywords: Sallekhana; Jainism; India; religious suicide; starvation; medical ethics; right to die INTRODUCTION Sallekhana, also known as santhara and samadhi-marana, is a centuries old religious ritual of starvation, considered by members of the Jain faith tradition to be the ideal form of death. For nearly two millennia the practice was an unquestioned and uncontroversial religious rite. However, the status of Sallekhana changed on September 24th, 2006 when human rights activist Nikhil Soni and his lawyer Madhav Mishra, filed a Public Interest Litigation (PIL) with the High Court of Rajasthan. The PIL claims that Sallekhana is a social evil and should be considered akin to suicide under Indian Penal Code Section 309 and Article 21 of the Indian Constitution, which guarantees the right to life. The legal petition also charges members of the Jain community who facilitate and support individuals taking the vow of Sallekhana with ∗ M.P.H., Candidate for M.A. in Biomedical and Clinical Ethics, Loma Linda University, Loma Linda, California, United States of America. 1 aiding and abetting an act of suicide.1 For the 4.2 million Jains living in India this legal petition is seen as a dismissal of the ancient philosophy they follow and a violation of Article 26 of the nation’s constitution, which guarantees the freedom of religion, and for the Jains, the right to die. This legal battle has led to a debate over right-to-die issues in India, where bioethics is a relatively new phenomenon (Puri 2005). The status of Sallekhana as a legal form of death has been accepted because of its religious affiliation, but euthanasia is banned and attempted suicide is an offense punishable by jail time. Hunger strikes are a common form of protest in India but often result in the protestors being forcibly hospitalized and charged with a criminal offense. In the 1996 case of Gian Kaur v State of Punjab2 the supreme court of India ruled that the right to live cannot be interpreted to include the right to die an unnatural death curtailing the natural life span (Mani 2003). Creating a bioethic that satisfies the philosophical and religious teachings of the multiple faith traditions of India is a daunting task, but what is perhaps even more challenging is the task of establishing an inter-faith and legal dialogue to address the issue of Sallekhana in the United States where there are between 60,000 and 100,000 practicing Jains (Kumar 1996) and there has been at least one documented case of Sallekhana (Davis 1990). The Jain community is adamant that Sallekhana is not comparable to suicide or euthanasia but is instead an act of spiritual purification and an exercise in autonomy. In a rapidly shrinking global community Sallekhana is increasingly becoming a matter of legal and ethical contention. 1 See Nikhil Soni v. Union of India and Ors. AIR (2006) Raj 7414. 2 See Gian Kaur v. State of Punjab. AIR (1996) Supreme Court; 83:1257-65. 2 RATIONALE OF SALLEKHANA By virtue of its teachings, particularly the belief in the sacredness of Sallekhana, Jainism poses serious ethical dilemmas for the medical community encountering practicing Jains in the clinical setting as well as for members of the non- Jain community whose personal ethics contradict Jain belief. For many people raised in the Western monotheistic traditions and particularly those in the medical profession in the United States the notion of deliberately acting to bring about one’s own death is viewed as both immoral and illegal. In fact, for the religions of the Abrahamic tradition, Jain theology is anathema. On a theological level it could scarcely be more different from Christianity, Judaism or Islam (Laidlaw 1995). In the United States where the influence of the monotheistic tradition’s understanding of right and wrong is so strong, finding a common ground may prove challenging. For Jains Sallekhana is understood to be the most peaceful and satisfying form of death and so in discussing the rationale behind Sallekhana a critical question comes to bear: how exactly is Sallekhana a non-violent, and thus spiritually superior method of ending life? It would seem that slowly starving to death is an act of violence against oneself. Whether or not starvation is painful is ultimately unique to the individual but depending upon the person’s general health certain vitamin or mineral depletion or electrolyte imbalances, along with intolerance for cold temperatures, dizziness, hair loss, extreme fatigue and ringing in the ears can be extremely painful and distressing (Keys, Brozek et al. 1950) (Kalm and Semba 2005). Jains acknowledge that while on the one hand Sallekhana is seen as a non-violent, even euphoric death, the suffering one experiences while in the process of starving allows the Sallekhana adherent to more fully understand the inherently painful and flawed nature of earthly existence. Additionally Jains view the process of starvation as the ideal method of exiting this 3 world in that they stop sustaining their own life at the cost of the other life forms they would otherwise consume. The Jain’s preferred method of meeting death cannot be properly understood independent of Jain philosophy. For Jains it is understood that the supreme goal of the individual is to minimize the damage one does to their environment and thus to tread as lightly upon the earth as possible. Also, for Jains it is accepted that religious devotion is difficult and often times painful. Asceticism is revered and practicing ascetics are worshipped (Babb 1994). To appreciate the importance of asceticism and its ultimate expression in the form of Sallekhana it is helpful to know the origins of Jainism. ORIGINS OF JAINISM The tradition, which may have originally began as a sect of Hinduism, traces its roots to a succession of 24 individuals, known as Jinas or Tirtankaras, in ancient East India. These Jinas are believed to have achieved the highest level of earthly incarnation and as a result Jains attempt to emulate the practices of these 24 people. Jainism is split into two sects, the Digambar and the Shwetambar. The exact reason for the split is not known but it is believed that sometime around the 5th century geographical factors played a role with the Jains of the Indian state of Gujarat evolving into the Shwetambars and the Jains of the surrounding states evolving into the Digambars (Roy 1984). While the doctrine of the two sects is largely the same, there is debate between the Digambars and Shwetambars over the issue of clothing, whether all of the Jinas were men, whether women are capable of achieving nirvana, and whether or not the Jinas were capable of experiencing disease. Shwetambars wear white robes, believe that the nineteenth Tirtankara was a woman named Mallahkumari and in the 4 concept of Sabastra Mukti, that women can attain salvation. They also accept that Jinas are capable of experiencing illness. Digambar Jains on the other hand, believe that a woman can observe the great vows and lead a true Jain life, but owing to certain physical infirmities peculiar to her sex, she cannot attain liberation in this life, but can do so in a future life if she is reborn as a man. Digambars also believe that Tirtankaras do not experience illness and they believe that the ninetheenth Tirtankara was a man named Mallinath (Choudhury 1956; Jaini 1979). Despite the aforementioned debate over female religiosity, both sects hold the same negative understanding of female nature as flawed and associated with sexuality and sin (Vallely 2002) . Interestingly, Shwetambar Jains, particularly Shwetambar women are statistically more likely to take the vow of Sallekhana (Baya 2006). The rationale behind Sallekhana comes from the Jain belief in karma, rebirth, asceticism and spiritual purification. Jainism teaches that the every living creature has an immortal soul called a jiva, which has consciousness and intelligence and which ideally should be able to ascend to the summit of the universe and achieve omniscience (Varni 1999). However it is karma that prevents the immaterial soul from achieving liberation. It is important to note that the concept of karma in Jain theology is very different from the understanding of karma in American popular culture. In American popular culture karma is often associated with notion of “what goes around comes around”, and a generalized belief that good deeds are rewarded and bad deeds are punished. However, for Jains karma is a much more sophisticated and developed belief system. The physical body is viewed as a prison for the soul and it is believed that karma is responsible for keeping the soul trapped within the body. Karma is understood to be an invisible supernatural substance composed of very fine particles that permeate the soul determining what physical form the soul will take.
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