Jainism and Social Consciousness Conference 2010: University of Ottawa

Sallekhana-Santhārā-Samādhīmaraņa and End-of-life Care: Jain Voluntary and Controlled Death in Equanimity through Fasting and Reduction of Activity as a Model for Secular Health Care

Pt. 1 in a series
Choosing to die: autonomy and assistance

Sean Hillman
M.A. (c) Religion (Buddhist Studies)/Bioethics
B.A. East Asian Studies
Department and Centre for the Study of Religion
Joint Centre for Bioethics
University of Toronto, CANADA

The three-fold process of Jain voluntary death practice, Sallekhana-santhārā-samādhimaraņa, has brought benefit to Jain practitioners for millennia and holds the potential to bring future benefit to both Jains and non-Jains. Among those who are non-Jains, some will embrace transmigration (or some other version of a post-death continuity of existence) and karma as part of their world-view and some will not. Are there aspects of Jain death practice that can be maintained without such religious ideas? The goal of this paper, in addition to clarifying some aspects of death brought on by the stoppage of oral intake and activity both in Jainism and in secular end-of-life care, is to show that there are some powerful Jain ideas and practices that can potentially help the dying and the bereaved without reliance on religion. Although secular bioethics is not amenable to some aspects of Jain voluntary death practice, I will attempt to show that in secular end-of-life care settings (not only palliative/hospice environments but also emergency, chronic, acute and critical care settings where many people also die) the Jain emphasis on: (1) voluntary and autonomous decision-making to withdraw treatment, including (but not limited to) nutrition and hydration, conjoined with (2) interdepedent decision-making with qualified co-decision-makers, and (3) qualified assistance and separation from objects of attachment, have great potential to assist the dying and bereaved in the pursuit of an improved experience during life’s most difficult time. To accomplish this I will use Jain monastic texts such as the Ācārānga Sūtra, Ācārya Amitagati I's Yogasāra-prābhrta (Gift of the Essence of Yoga) and the Bhagavatī Ārādhanā, as well as the Catholic Health Ethics Guide and the Health Care Consent Act.