By Brianne Donaldson.
On August 10, 2015, the Rajasthan High Court outlawed the ancient and rare Jain practice of fasting unto death on the basis that it is not “an essential religious practice” protected by Article 25 of the Indian Constitution protecting freedom of religion. Nor is the “right to death” protected by Article 21 that ensures the right to life and property. This case highlights a fundamental bioethical tension between killing and letting die that remains unresolved in debates around the world. Framing the Rajasthan issue merely in religious terms obscures the impact this case could make in wider bioethical debates over the definition of life and the conscious choice of death.
Jainism is a minority tradition in India dating back at least 2,500 years. Jains are distinguished by their active effort not to harm other people, plants, animals, or oneself. Jains also assert that no single perspective is complete, and that non-harm includes reducing attachment to material possessions. The Jain practice of sallekhanā is considered a form of “sacred death” undertaken by few Jain monks and nuns, and occasionally laypersons. As expressed in its native India, sallekhanā involves an intentional vow to gradually decrease the intake of nutrition from solid foods to yogurt, then to milk, then water, finally abstaining from all hydration. In theory, the vow can only be undertaken once serious illness—or a malady such as blindness or immobility that prevent a monastic’s observation of daily responsibilities—has taken hold, and must commence under the guidance of a spiritual teacher. In Jain history, there were also special cases when the fast to death could be taken during a time of drought, famine, or warfare.
Jains understand sallekhanā as an ultimate expression of their ethical commitment to reduce injury toward other life forms insofar as even digestion has a cost on individual organisms. It is also seen as a preeminent expression of nonattachment to a separated Self and to the fear of death. Given the Jain understanding of a soul, or vital life force called jīva, as distinct from the body, sallekhanā is seen as the dignified cessation of the karmic costs of existence as a body succumbs to illness. Voluntarily ceasing one’s impact on other life forms and transferring concern for the Self to wider relations is thought to reduce the number of lifetimes required for a jivā to attain, or reclaim, its full capacity of perception and feeling, known as mokṣa.
In the Rajasthan case, petitioner Nikhil Soni argued that sallekhanā (also called santhārā, meaning “deathbed”) is a religious practice tantamount to suicide that conflicts with the state’s mandate in Article 21 to protect an individual’s right to life. Moreover, the practice is not essential for membership in the Jain community nor for achieving spiritual goals. Perhaps most significant, the petitioner cited cases in which he believed vulnerable individuals had been coerced into sallekhanā by family members who sought to improve their social status through the public ritual or to relieve themselves of the burden of an incapacitated elder, such that the practice should be equated with “culpable homicide” or, as described in a press release, “ritual murder.”
The Jain respondents in the case insisted that sallekhanā is not a form of suicide as it not done from despair nor as a means to escape life. The respondents’ offer examples of the sacred fast from texts, historical records, and contemporary communities which “ . . . are not cases of extinguishing life but only of accelerating conclusion of the process of natural death which has already commenced.” To put it another way, it is an example of “letting die” rather than an active pursuit of death. The respondents assert that sallekhanā requires no medicine, tools, or weapons to violently cease bodily function, nor is it done in secrecy or shame. Rather, fasting unto death is a public and auspicious act witnessed by a community who supports the individual’s spiritual goals in song, prayer, and other acts of comfort.
The court’s controversial decision will certainly be challenged by factions within the Jain community. But will the challenge come on the grounds of Article 25, that sallekhanā is a protected religious practice, or on the grounds of Article 21, that the right to life and property should include the freedom of conscious individuals to decide their own death? Or will it depend on some new Article yet to be clarified, both in India, and in countries around the world?
Here, the Jain community could make a tremendous contribution to the wider public conversation on the definition of death. Death is, after all, not merely a clinical issue, but as bioethicists Culver and Gert have argued, “defining death is primarily a philosophical task.” The way that a state defines what constitutes life and death has tremendous impact on the responsibilities of medical professionals, as well as the freedom or criminalization of individual decisions on how best to approach death.
The early clinical criterion for death was heartbeat and respiration. With the cessation of these, the person was considered dead. Yet, the advent of artificial respiration made it possible to keep a body alive in spite of damage to these systems. Furthermore, certain injuries affect only the cognitive portion of the brain, while involuntary breathing and heartbeat remain functional. In such situations, what criterion does a medical professional use to define the moment of death, especially if organ function persists?
Bioethics wrestles with these philosophical conundrums that clinical science cannot answer: does the subject, person, or “self” of life reside in the body, or in the brain, in the active participation in relations, in the expectation of a future, or in some combination of all the above? “The underlying general idea,” according to ethicist Martin Benjamin, “is whether being alive is, for the likes of you and me, solely a matter of biology or whether it also involves consciousness . . . This is a philosophical question, not simply a matter of definition.” Even criteria such as “persistent vegetative state” (PVS) do not clarify how long such a state must “persist” to qualify as persistent. Notable PVS cases such as Terri Schiavo—whose husband successfully petitioned for the removal of a feeding tube while her parents sought injunctions to keep the tube in—reveal the deep ethical unease between killing a person and letting her die.
The Hippocratic Oath to “do no harm” is even less clear on the tension of killing/letting die when it comes to euthanasia of clearly conscious patients. In the U.S., voluntary active euthanasia—in which a person requests a physician to administer a terminating drug—is a criminal offense. Physician-assisted euthanasia—when a physician provides a lethal dose of a drug that must be self-administered by a patient who has met established criteria—is only legal in three states. The only practice affirmed by the American Medical Association Council on Ethical and Judicial Affairs is known as terminal, or palliative, sedation, in which a terminally ill person suffering from unbearable pain, shortness of breath, delirium, or persistent vomiting may by put under deep sedation for the last hours or days of life. The sedation is maintained until a patient dies by the underlying illness, or according to David Orentilicher “from a second step that is typically part of terminal sedation—the withholding of nutrition and hydration.” Although terminal sedation is seen as reducing symptoms of suffering, bioethicists also describe it as a form of slow euthanasia.
The issue, then, still hinges on whether the state can condone the choice of a conscious individual to undertake steps to end his/her own life, and under what circumstances. This question has bearing for the global population, and is not merely a religious issue for Jains alone. That said, Jains—who have a well-documented tradition of sallekhanā as a mode of death that reflects a deep philosophical world vision—are well positioned to share their understanding of death, not in opposition to life, but as an aspect of an ethical life. Sallekhanā does not require physician-involvement, nor the active or violent ending of life, and there are established criteria for its use as a form of intentional “letting die.”
Certainly Jains will ground this argument in their unique metaphysical system that sees the body and jīva as distinct-but-entangled over many lifetimes. While this framework will not apply to everyone, it is clear that even secular patients struggle to articulate a selfhood or personhood that must be given precedent above the state’s mandate to protect the right for a body to survive at all costs, both legally in terms of criminalizing the voluntary death of a terminally ill person with fines and imprisonment, and literally, in terms of medical expenditures.
The abuse of sallekhanā, or any form of voluntary death, whether for social status or financial relief, is a real consideration in a world of complex power relations. Yet, we also must ask to what degree instances of individual coercion justify much wider forms of political coercion. Are there any safeguards or legal criteria that can be established to protect an individual’s right to choose death while protecting others from being pressured toward the option, such as the impressive Oregon Death with Dignity Act?
The Jain practice of sallekhanā sees that all life has a cost. When death is near, an individual may choose a path for themselves, and on behalf of others, to cease exacting that cost. As bioethicist Leon Kass remarked, “The culture that seeks indefinite prolongations of its own life beyond the fourscore of a full life is a culture that is increasingly hostile to renewal and to children.” The sacred death of Jain sallekhanā emerges from a philosophical recognition of the immense value of all life and related life-affirming possibility of an ethical death.
 See the Court’s decision at http://rhccasestatus.raj.nic.in/smsrhcb/rhbcis/judfile.asp?ID=CW%20%20%20&nID=7414&yID=2006&doj=8/10/2015.
 Yogesh Pawar, “Rajasthan High Court holds Jain fast-unto-death illegal,” DNA India, August 11, 2015, accessed online August 11, 2015 at http://www.dnaindia.com/india/report-rajasthan-high-court-holds-jain-practice-of-fast-unto-death-illegal-2113095.
 Charles Culver and Bernard Gert, “The Definition and Criterion of Death” in Biomedical Ethics, 6th Ed., Ed. Thomas Mappes and David DeGrazia (New York: McGraw-Hill, 2006), 313.
 Martin Benjamin, “Pragmatism and the Determination of Death,” in Biomedical Ethics, 6th Ed., Ed. Thomas Mappes and David DeGrazia (New York: McGraw-Hill, 2006), 321.
 David Orentilicher, “The Supreme Court and Physician-Assisted Suicide: Rejecting Assisted Suicide but Embracing Euthanasia,” in Biomedical Ethics, 6th Ed., Ed. Thomas Mappes and David DeGrazia (New York: McGraw-Hill, 2006), 414.
 Leon Kass, Transcript from NOW with Bill Moyers, July 25, 2003, accessed on August 11, 2015 athttp://www.pbs.org/now/transcript/transcript_kass.html.
BRIANNE DONALDSON is Assistant Professor of Philosophy and Religious Studies at Monmouth College, as well as an independent researcher for Vegan Outreach. She explores the intersection of Indian and western metaphysics—especially Jainism, Whitehead’s process-relational philosophy, critical animal studies, and religion and science. Her work aims to widen notion of the political, moral, and embodied community to include co-creative entities currently divided out as so-called animals, plants, and ecosystems. Donaldson is the author of Creaturely Cosmologies: Why Metaphysics Matters for Animal and Planetary Liberation (Lexington Books 2015) and an edited collection Beyond the Bifurcation of Nature: A Common World for Animals and the Environment (Cambridge Scholars Publishing 2014).