Voluntary death in the epics Mahābhārata & Rāmāyaṇa

Sean Hillman, 2011
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

A special category of death finds its way into both the epic Mahābhārata and Rāmāyaṇa, that of voluntary death. Sometimes referred to as “self-willed death”[i], such deaths can be further sub-categorized into suicide, heroic and religious. The first has historically been given much more attention in the mass media and academia. Proof of this can be seen in the abundance of court cases and bioethical research that ponder on suicide, Physician Assisted Suicide (PAS) and euthanasia in contrast to that having to do with heroic and religious voluntary death. Most people, when asked, do not easily recognize these latter two categories, which Young calls mors voluntaria heroica and mors voluntaria religiosa respectively[ii], but would typically have a well-formed opinion about the motivations behind, and results of, suicide. Although both deserve much more scholarly attention, this study will keep religious voluntary death as its primary focus. Among religious voluntary deaths there are various types of such a purposeful and consciously directed end to life. These are: The Great Journey or walking in an auspicious direction until falling dead (Mahāprasthāna), sacrificial self-immolation (Agnipraveśa), regular immolation, drowning in rivers and ponds (Jalapraveśa), fasting to death (Anaśana or Anuśān-parva), on the banks of holy rivers, death while in meditation (samādhimaraṇa), abstaining from food and awaiting the approach of death in a seating posture (prāyopaveśana),[iii] and by yogic manipulation of the breath and inner energies resulting in the projection of consciousness (utkrānti)[iv]. How do such deaths differ from ordinary deaths? This study aims to establish that the epics portray religious voluntary death as specifically counteracting some or all of the themes that accompany ordinary death, namely: fear, fate, causality, pursuit by the Lord of Death, loss of senses and breath, dissolution and embodiment. Firstly we will look at how death (as the end of life) and Death (the personified reaper of souls) are presented in each of the twin epics’ third sections, the forest books in particular, while looking at some of the material beyond these books as well. The analysis of death in the Rāmāyaṇa will be particularly linguistic in nature. Next will follow an outline of the various types of religious voluntary deaths found in both, or one or the other, of the twin epics. Lastly, we will look closely at the voluntary deaths of the main protagonists of the epics, the Pāṇḍavas in the Mahābhārata, and Rāma in the Rāmāyaṇa, to establish whether voluntary death counteracts the above-mentioned themes that accompany ordinary death.

Death and death in the Epic Forest Books

If we are to show how religious voluntary death is utilized in the twin epics, first it is necessary to establish how death is presented and contextualized in each. I will start with the Rāmāyaṇa since I have at my disposal Pollock's line-by-line Sanskrit transliteration to assist in locating terminology.

A rigorous survey of The Forest Book of the Rāmāyaṇa reveals that Death and death are distinguished between each other, and are presented in repetitively particular ways. Death is personified as the taker of life, whereas death is a physiological and psycho-spiritual transformation of the individual.

The personification of Death serves several functions: as a metaphor for attackers/harmers; as an object of fear; and as a representation of the bestower of fate and punishment. Pollock's translation often conflates several Sanskrit terms with the same English terminology, so teasing out these terms will prove useful.

Death is portrayed as male, and his image is evoked in descriptions of attacking enemies in battle. In their first encounter with a rākshasa since entering the forest, Virādha attacks the forest dwelling trio Rāma, Lakśmana and Sīta “…like Death (āntaka) attacking people.”[v]rākshasa Khara describes his sister Shurpa-nakha as one who goes about “like Death (āntaka) himself.”[vi] There are many other instances of rākshasas being described this way in the Rāmāyaṇa Forest Book, as moving about the world in a harmful way like Death himself, with āntaka as the operative term.[vii] In these cases, the usage of āntaka makes sense as it is usually translated as 'destroyer.' The For example, the shared Buddhist and Shaiva tantric deity Yamāntaka is known as 'the destroyer of death', and "Krishna…is famous as śrīśa khacū āntaka, the blessed destroyer of the demon Shankhachuda."[viii] In Pali, āntaka is sometimes translated as Evil One, in masculine form, and made synonymous with māra.[ix] This is a fascinating linguistic connection, since māra is subdivided in both Hindu and Buddhist texts as a harmful force with internal and external aspects. Berzin explains that in Hindu mythology, "[t]o rouse Shiva, Kama shot five arrows from his bow. These arrows were to make one ecstatic,…to make one crave,…to make one stupefied,…to make one thin, emaciated and dried out,…to make one dead. These five are called the five types of troubles that are the work of Mara."[x] In Buddhist mythology, since "[t]he term mara derives from the Sanskrit root mr, to murder…mara is what murders or causes interference to us… Mara is also explained as “what puts an end” (mthar-byed, Skt. antaka) – that which puts an end to spiritual practice. There are four types of mara: the mara of death (the Lord of Death), the mara of disturbing emotions and attitudes, the mara of the aggregate factors of experience (the five aggregates), the Mara who is the son of the gods."[xi] Additionally, the mara of death is further subdivided: "Mara is also considered Yama (gShin-rje), the Lord of Death (‘Chi-bdag)…outer Yama is death itself…inner Yama is the disturbing emotions and attitudes…hidden or secret Yama is the three subtlest conceptual minds.”[xii] Bearing this in mind, as some of these points will prove useful later in this study, the usage of āntaka in our Rāmāyaṇa Forest Book context is clearly Death as an external harmer bringing an end to life, evoked as a metaphor to describe Rāmāyaṇa players who are harmers likewise bringing death to others.

Next is the usage of Death as a fearsome object. With this application, several terms are used: āntaka, mṛtyu, mukta and kāla. The appearance of the rākshasa Virādha is “…as terrifying to all creatures as Death (āntaka) with jaws agape.”[xiii] This fearsome image of Death hungry for the living is recurring, with āntaka as the Sanskrit appearing each time.[xiv]āntaka) with noose held ready”[xv], but these are the only instances where this portrayal of Death as prepared to choke the life from his victim has Death as āntaka. The metaphor of Death as prepared to strike his victim with an implement straddles several Sanskrit terms. Khara is twice at the ready in battle “like Death (The female rākshasa Shurpa-nakhaSīta “like the very noose of Death (mṛtyu)[xvi], and Rāma attacks the rākshasa legion “like noose of Doom (mukta).”[xvii] attempts to strike Here we have the introduction of two additional Sanskrit terms, mṛtyu for Death and mukta for Doom, another English term for Death personified. Mṛtyu is translated as death[xviii] and mukta as liberated[xix], so we have three quite different Sanskrit terms subsumed into the same repeated image. Mṛtyu seems to be the predominant usage to specifically portray the fearsome nature of Death. The rākshasa Khara states that “[i]n my rage I could throw the fear of death (maraṇa) into Death (mṛtyu) himself,”[xx] and while abuducting Sīta, the rākshasaRāvana instills terror since “…seeing him advancing like Death (mrtyu) himself, the spirits of the forest fled overpowered by fear.[xxi] Rāvana also informs Sīta that "…all things born are put to flight by fear of Death (mrtyu)."[xxii] The last Sanskrit term used during portrayals of Death as fearsome is kāla, time: "Then suddenly Rāvana…abandoned the kindly form of a beggar and assumed his true shape, one such as Doom (kāla) itself must have. With eyes flaming bright red, with earrings of burnished gold, with bow and arrows, he become once more the majestic ten-faced stalker of the night."[xxiii] Although Pollock presents Death as 'Doom' with two Sanskrit terms, mukta and kāla, for the one English word, this is not an isolated usage of kāla for Death. Just prior to Lakśmana’s death, Yama the Lord of Death himself, in the form of an ascetic, comes to have a private discussion with Rāma and in the Dutt translation of the Rāmāyaṇa, Yama is referred to as Kāla.[xxiv] The Lord of Death also goes by the name of Yama in The Forest Book of the Rāmāyaṇa, but in all but one instance in relation to his underworldly (and assuredly frightening) location: the “house of Yama”[xxv] and his abode.[xxvi] Our discussion of Death’s title ‘Kāla’, given it’s relation to time and the connotation of impending disaster that comes with ‘Doom,’ makes this an appropriate moment to move to the last major purpose for Death personified appearing in The Forest Book of the Rāmāyaṇa: Death as the bestower of fate and punishment.

Here, too, we start with Death the destroyer, āntaka, who is wont for “…attacking people at their fated hour (kāla).”[xxvii] Here the implications are that life-spans are indeed limited, as time for a person runs out in that final hour, and that that time is predetermined by some means. Whereas Death here is still a personified force external to the individual, kāla, rather, seems to belong to the person. Death is implementing the end of life that is according to a specific timing of the individual. This is unlike the other usages we have seen of Kāla as personified Doom or Yama synonym. While in the clutches of the cursed and disfigured Kabāndha, Rāma bemoans to Lakśmana when it seems that their demise is inevitable: “How great the power that doom (kāla) exerts against all creatures… Is not fate (daiva) too much for any creature to endure…? Powerful heroes expert in arms can be overcome by doom (kāla) and collapse on the field of battle like dikes made of sand.[xxviii] Interesting that the term bhāgya does not appear for doom or fate, but rather kāla, also translated as ‘time’, and daiva,Kāla again is translated as ‘doom’ but without capitalization. sometimes translated as ‘destiny.’ If this is not a mistake, could it be a subtle differentiation between Doom and doom with the former being an objective force and the latter a subjective one, as with Death and death? Perhaps. Suffice it to say that fate and doom/time again give one the sense that the end of life is inevitable, merely a matter of time, and that when that time runs out is predetermined. The personified Death is often referenced as the one who dispenses with life, but here the end of life appears to be the result of deeds: “the power of kings is infinite…they can exact punishment like Yama.”[xxix] We could sum up this section by stating that the end of life coming about by an internal kāla or external Kāla could remain a matter of perspective, as the text seems to point to both.

Moving from the personified Death to the death of the individual, not only does a similar theme of time appear as well, but also some unique aspects: that of the loss of one’s senses and breath in the process of dying.

The rākshasa Khara scolds Rāma for being haughty “…when the hour of his death (mṛtyu kāla ) is at hand…”[xxx] Thus far we have shown mṛtyu and kāla mostly translated as Death and Doom, respectively, and also ‘fated hour’ and ‘doom’ for the latter. Having the two terms together, here, has been interpreted by Pollock as having more to do with the death of the individual, rather than the objective and personified Death. However, given the other usages of kāla, it would not be a stretch to read this phrase as having also to do with fate as well.

The loss of sense faculties and breath also seem to accompany the loss of life in the individual in the The Forest Book of the Rāmāyaṇa. Khara says to Rāma: “You have lost all sense of what to say and not to say, because Death (mṛtyu) has you in his power. For once the noose of Doom (Kāla) is wound around his neck, a man no longer knows what is or is not to be done, and all six senses fail him.”[xxxi] Later, Jatāyus the great vulture proclaims while in the throes of dying that “…everything is swimming before my eyes. I see the golden trees now and their streaming hair of spikenard!”[xxxii] In both examples is mention of the senses failing as death approaches, including the mental faculty. The author has Khara speak of the loss of knowing appropriateness, and Jatāyus seems to be describing the onset of a vision. Is he having a glimpse of his destination after death? Jatāyus also describes the increasing difficulty of his dying experience when he states that “[m]y breath is coming harder…”,[xxxiii] and, alas, his life ends when he “…let go the breath of life and could capture it no more.”[xxxiv] Much later in the epic, outside of the Forest Book, a death is again described in such a way when “Kausalya, Rāma’s mother, breathed her last.”[xxxv] The loss of breath, clearly, is presented as the main indicator of the loss of life of an individual. What indicates death in the Mahābhārata?

Shifting now to the other of the twin epics, the Mahābhārata, the analysis of the presentation of death will be based less on linguistics since I do not have a line-by-line Sanskrit transliteration of this text. Regardless, we will take what we have gleaned from the Rāmāyaṇa’s presentation of Death and death in The Forest Book and see what differences and similarities we can find in the Mahābhārata’s Forest Book.

One key feature of the Mahābhārata’s unique presentation of death is an emphasis on the body as the physical embodiment of the soul that is absent from the Rāmāyaṇa. In questioning the ascetic Mārkaṇḍeya on the nature of actions and their results, Yudhiṣṭhira refers to death as the “…embodied soul…shedding his body…”[xxxvi] We see this in the Santi Parva Book also when Brigu states that “The body alone dissolves away. The living creature, though depending upon the body, does not meet with destruction when the body is destroyed.”[xxxvii] Again, in the same book, Bhishma is made to say that death is when “[t]he embodied soul…[is] divested of Rajas.”[xxxviii] This ‘Rajas,’ according to the Samkhya school, is “one of the three gunas” or qualities and is specifically “[that which] is responsible for motion, energy and preservation.”[xxxix] This points to another aspect of death that the Mahābhārata marks as important, that of the departure of the animating force. In the same Santi Parva book, the ascetic Parsara says this of death: “Abandoned by the owner, the body becomes inanimate and motionless. Indeed, when the primal ingredients return to their respective natures (merge into the five elements), the body mingles with the dust… Jiva (the embodied soul), after dissolution of the body it inhabited…”[xl] This loss of animating life-energy accompanies the body’s dissolution at death which Bhishma calls “the destruction of this gross body”[xli] and of which Mārkaṇḍeya states that “[a]t the end of his life he abandons his mostly deteriorated carcass…”[xlii] What is it that abandons the body at death? We can safely assume that it is the soul referred to in the other passages. Dissolution upon death is even mentioned in the Mahābhārata’s telling of Rāma’s story with the death of Rāvaṇa: “The five elements departed from the lordly Rāvaṇa, for he was toppled…”[xliii]

With these excerpts we have shown several themes that sets the MahābhārataSanti Parva, apart from that in the Rāmāyaṇa’s Forest Book. There are, however, some commonalities. presentation of death, in the Forest Book and the

We saw earlier that the Rāmāyaṇa considers death as every being’s fate, an inevitable end that comes with having life, and we find this in the Mahābhārata as well. Parsara states that, necessarily, “…[d]eath follows birth in respect of all men…”[xliv] and even Rāma himself, in the Mahābhārata, is made to say that death is “…the final destination of all creatures.”[xlv] But before we get the impression that the Mahābhārata holds death as unpredictably inevitable, the text also seems to reinforce the Rāmāyaṇa’s consideration of death as set, predetermined, fated. In the Mahābhārata’s Rāma section, “King Daśaratha succumbed to the body’s Law of the passing of time.”[xlvi] This seems to resemble the internally-driven fate of the individual, but Mārkaṇḍeya proclaims this verse: “Behold, O King, all the various creatures, [h]ow all according to kind with force, [a]ct out what the Ordainer ordained for them”[xlvii] Although we have here an ‘Ordainer’ which we do not find in the Rāmāyaṇa, we nevertheless can see the parallel with there being an objective, external force that brings about the various circumstances of beings, including death. In the Rāmāyaṇa we have shown this to be Death and Doom personified, interchangeably āntaka, mrtyu, mukta,Yama and Kāla. Not the omnipotent ‘Ordainer’ of the Mahābhārata, but functioning in the same way in both epics as an objective bestower of death.

Lastly, a major point of departure from the Rāmāyaṇa is the Mahābhārata’s venturing beyond mere fate as the cause of circumstances, death included, and adding the cause and effect of actions into the formula. Actually, Mārkaṇḍeya gives three contributing causal factors to the circumstances that beings find themselves in: “Some comes from fate, some from chance, some from their acts.”[xlviii] With regard to death specifically, Mārkaṇḍeya seems to outright reject death by fate when he states that “[t]hose who lack the eye of insight believe that this creature is governed by the rule of death and is unaffected by either good or bad markings; but this has been declared to be the course of the stupid.”[xlix] As this particular dialogue is prompted by a question put to the ascetic concerning the way in which actions follow beings, the ‘good and bad markings’ which affect the type of death one has can confidently be said to be from previous actions. Thus, the text here shows tension between different positions on what influences death: that of predetermination by an objective supernal being, and self-determination by way of actions. We see this tension even within the confines of the discourses of one individual ascetic, Mārkaṇḍeya, without even addressing the third contributing causal factor he presents, that of events being undetermined and randomized, or by ‘chance.’ This sort of tension appears absent from the Rāmāyaṇa, since the death fate of the individual and the objective implementation of that fate by Death personified seem to harmonize quite well. The external Death is merely the means by which the death fated to the individual is brought about.

Given the various themes that occur around Death and death, and in light of our upcoming sections of religious voluntary death, I will suggest that it is these very things that such a unique mode of dying is utilized to counteract. In other words, does religious voluntary death aim and/or succeed in counteracting: fate; causality; the attacks of Death and Doom or the Lord of Death; the fear of Death and death; and the loss of senses and breath? What about embodiment and the inevitability of death? Does voluntary death lead to an end to embodiment and death itself, bringing about an entirely new status for the soul? Let us see.

Voluntary Death(s) in the Epics

Religious voluntary death is a known phenomenon to the cast of the Rāmāyaṇa. While approaching the abode of the sage Agāstya, Rāma notes that this is a particularly auspicious location where “great beings cast off their bodies (tyaktvā dehān) and in new bodies ascended to heaven as supreme seers.”[l] In the Mahābhārata too, religious voluntary death is presented as a particular way of dying that does not require much explanation. Mārkaṇḍeya states during his cosmological discourse that “in the beginning…men died when they wanted…”[li] Precisely how are these death practices performed?

A book by Śreyas on Jain Voluntary Death[lii] gives a fairly thorough survey of voluntary death as found in traditions other than Jainsim, including those found in Hindu texts. I will use this, in part and with qualifications, in order to establish which types of voluntary death are uniquely found in one or the other of the epics, and which are found in both texts. There are a few voluntary deaths that Śreyas fails to mention, and one which I feel is misconceived. I will address them each.

Starting with the Rāmāyaṇa Forest Book, the Vedic sacrificial self-immolation of Śarabhaṅga Ṛṣi,[liii] which Śreyas calls Agnipraveśa,[liv] seems to be the only type of voluntary death that occur solely in this epic and not in the Mahābhārata. One might be inclined to include Dhritrashtra’s voluntary death by fire in this category, but I am not so inclined since the fire was not sacrificial. Rather, it was a “fire in the forest, which slowly envelop[ed] the hermitage. Dhritrashtra knew it was time to leave the body and travel further on. He sat down…facing eastwards in yogic posture and calmly gave himself up to the flames. Thus ended the life of the elder son of Vichitravirya and Ambika, born blind.”[lv] This assuredly is a voluntary death by immolation, but not Agnipraveśa. We can give this voluntary death its own category, voluntary death by naturally arising fire, and say that it occurs only in the Mahābhārata. Also in the Rāmāyaṇa Forest Book we find two indeterminate voluntary deaths, those of the ascetic Sutīkshna who, like Śarabhaṅga, also awaited a meeting with Rāma[lvi] and the female ascetic Shābari who “had gone to heaven by her own act….”[lvii] before “leaving my body behind on the earth”,

By the account of Śreyas, there are three types of religious voluntary death that occur only in the Mahābhārata, but I contest one of them as being not exclusive to this epic. The first is the “irrevocable last great journey (Mahā-prasthāna) [f.9: Mahābhārata Vanaparva, 85.85]…[where one is] subsisting on water and air alone and walking on in an auspicious direction until the end of one’s life…”,[lviii] which the Pāṇḍavas engage in, an the second is “fasting to death (Anaśana) [f.12 Mahābhārata (Anuśān-parva) 25.63,64].”[lix] What I contest is Śreyas’s position that voluntary death on the banks of holy rivers only occurs in the Mahābhārata. I consider the voluntary death of Lakśmaṇa to be of this type (but not exclusively of this type) and, therefore, I also disagree with Śreyas including Lakṣamaṇa’s voluntary death among those that are by drowning in rivers and ponds. His death was on “the banks of Saraju”[lx] and had a yogic component that Śreyas does not mention. I will discuss this when I come to the third type of voluntary death that occurs in both epics.

Of the three types of voluntary death that occur in both the Rāmāyaṇa and Mahābhārata, Śreyas only recognizes one: that of “…drowning in rivers and ponds (Jalapraveśa) as in the cases of…Lord Rāma accompanied by Bharat, Śatrughna, his subordinate kings and the citizens of Ayodhya. [f.3: Rāmāyaṇa, Uttara Kāṇḍa, 110.2] By drowning in the confluence of three holy rivers at Prayag [f.4: Mahābhārata Vanaparva, 85.85]”[lxi] As I mentioned, Śreyas includes Lakṣamaṇa’s death here (and I do not), and excludes his death also from the following: “…embracing voluntary death on the banks of holy rivers… [f.6: Mahābhārata, Śalyaparva 39.33].[lxii] Since I include Lakśmaṇa’s voluntary death here (Rāmāyaṇa, Uttara Kāṇḍa, 106.8), it is another type of voluntary death seen in both epics. The third type of voluntary death that I see occurring in both epics we can call a yogic death, which White calls utkrānti.[lxiii] I include the voluntary deaths of both Lakśmaṇa and Bhishma[lxiv] in this category. Allow me to justify this category, and also why I exclude Lakśmaṇa from that of drowning and have him straddling two categories, voluntary death by yogic means and that on the bank of a river.

According to Dutt’s translation, Lakśmana clearly chose to die. “Lakshmana thought within himself: ‘My own destruction is far more desirable then that of all.’”[lxv] He then “reached the banks of Saraju and rinsed his mouth he stood there with folded palms.”[lxvi] There is no indication here that he entered the water, so we cannot call this voluntary death by drowning. As for the yogic component, “having obstructed all passages he did not breathe any more…being thus engaged in penances, having obstructed his breath, Apsaras, Indra and other deities and Rishis showered flowers upon him. Thereupon beyond the sight of men, having taken the highly powerful Lakshmana within his body, the king of celestials enetered his own city. Thereupon beholding Lakshmana, the fourth portion of Vishnu arrived at their city the celestials were greatly delighted and engaged in his worship.”[lxvii]Mahābhārata, Bhishma “held forth his life-breaths successively in those parts of his body which are indicated in Yoga… The life-breaths, restrained and unable to escape through any of the outlets, at last pierced through the crown of the head and proceeded upwards to heaven.”[lxviii] Although the internal processes are explicitly mentioned in the case of Bhishma and not in the description of Lakśmana’s death, the parallel is striking. Similarly, in the White specifically mentions “Bhīmṣa…as one who had died spontaneously, of his own free will”[lxix] and states that when “Abhinavagupta invokes a precedent for the practice of utkrānti [upward advance], he refers to Bhīmṣa.”[lxx]

The Voluntary Death(s) of the Epic Heroes

Lastly, we will look closely (but briefly) at the voluntary deaths of the major heroes of the two epics, Rāma and the Pāṇḍavas, to try and answer our questions about whether voluntary death serves the function of counteracting the various aspects of ordinary death that we outlined earlier. Specifically we aim to see if voluntary deaths contravene: fate; causality; the attacks of an objective, personified Death; the fear of Death and death; the loss of senses and breath; embodiment and, death itself.

First we will look at the voluntary death of Rāma. “Having forsaken Lakshmana and being stricken with sorrow and grief Rāma said to his citizens and ministers: ‘I shall to-day repair to woods… I shall follow the way which has been wended by Lakshmana.’”[lxxi] In following the way of Lakśmana, Rāma proceeds to the same body of water to abandon the body but I do not take this to mean that because Rāma enters the water, that this retroactively reinforces the idea that Lakśmana entered the water since the text does not indicate this. Following Lakśmana also indicates that Rāma knows that he will have the same ultimate destination as his brother as shown by “…Rāma`s determination of going to heaven…”[lxxii] Although Rāma feels grief over his brother, the parade of those accompanying Rāma to either join him or merely witness his departure, it is not an event marked with sorrow. “There was none poorly, aggrieved or miserable – all of them appeared wonderfully happy and delighted.”[lxxiii] The communal mood, Rāma’s determination and confidence in knowing he will ascend could all indicate that there is no fear on his part in following this voluntary death. Next, “the descendent of Raghu espied Saraju of holy waters flowing towards the west. And… Rāma, with his followers arrived at the place where he should give up his person. Thereupon at that moment, Brahmā…arrived there where Kākuthstha had addressed himself to repair to heaven… Thereupon the Patriarch gave vent… ‘Come O Vishnu…do thou enter here with thy brothers, resembling the celestials in brilliance in whatever form thou likest – either in that of the sky or in thy own Vishnu form…’ …Hearing the words of the Patriarch and determining everything the high-minded Rāma entered there bodily with his brothers in his Vishnu form.”[lxxiv] From this description, we also note that there is no presence of Death personified, or fear of such. Even though Rāma and Kāla/Yama engaged in conversation earlier, there is no indication that Death is in any way involved in Rāma’s chosen death. Nor is there any mention of fate or causality, so it is difficult to say whether this voluntary death has counteracted the force of either. Finally, as Rāma’s voluntary death is followed by bodily entrance into the celestial realm, albeit in his supreme form, it would be difficult to say that Rāma sloughed off the gross body in an ordinary way since the transition is a seamless one from human to divine form with no apparent residual, nor the loss of senses or breath. This death is not only extraordinary because of its voluntary nature, but also because there seems to be no gap during which the human body would perish by drowning and shift into a divine form. Even though we include this voluntary death in the category of drowning, we could say that this is indeed a transcendence of death itself since this translation of the text shows none of the typical signs of death, such as dissolution and the end of breath, but rather an instantaneous movement from human to god.

Moving to the Mahābhārata for our last inquiry into voluntary death, the Pāṇḍavas "[h]aving heard the particulars of the great slaughter of the Vrishnis… and having been informed also of Krishna’s ascension to Heaven…the Kaurava king set his heart on leaving the world… His brothers also formed the same resolution. Then Dharma’s son, Yudhishthira, the king of the Kurus, casting off his ornaments, wore barks of trees. Bhima and Arjuna and the twins, and Draupadi also of great fame, similarly clad themselves in bark of trees… The five brothers, with Draupadi forming the sixth, and a dog forming the seventh, set out on their journey. Setting themselves on Yoga, those high-souled ones, resolved to observe the religion of Renunciation, traversed through various countries and reached diverse rivers and seas.”[lxxv] Right off the bat, we see that, like Rāma, the entrance of the Pāṇḍavas into the Great Journey is triggered by grief. Rather than the fear of death, we could say that they fearlessly enter into this voluntary death practice because they cannot bear to be without Kṛṣṇa and, also like Rāma, know that they will be reunited. Then each of the troupe begin to fall down, one by one. “Yajnaseni, falling of from Yoga, dropped down on the Earth… Yudhishthira said: ‘O best of men, though we were all equal unto her she had great partiality for Dhananjaya. She obtains the fruit of that conduct today, O best of men…’ Then Sahadeva of great learning fell down on the Earth… Yudhishthira said, ‘He never thought anybody his equal in wisdom. It is for that fault that this prince has fallen down.’”[lxxvi] As each of the Pāṇḍavas fall, an explanation is given as to why they drop when they do. Here, with the repetitive mention of causality, we see one of the major differences between the voluntary deaths of Rāma and the Pāṇḍavas. Although the Pāṇḍavas all ascend, the exact time of the deaths of all but Yudhishthira is causally determined. It is the function of their voluntary deaths to attain a heavenly state, an end which we see no indication being determined by fate, causality or the reckoning of the Lord of Death. With all but Yudhishthira, also, we can safely assume that there was an actual death process involving the loss of breath and dissolution of the elements and therefore not being an embodied ascension. They died, “[h]aving cast off their human bodies”,[lxxvii] but it is not clear whether there was any accompanying delirium or what we have been calling a loss of senses. Although they attained heavenly status, it cannot be said that the Pāṇḍavas transcended death as we might consider of Rāma. Yudhishthira, however, is told by Indra that “it is ordained that thou shalt go thither in this very body of thine.”[lxxviii] As with Rāma, Yudhishthira’s has a divinely escorted embodied ascension. However, unlike both Rāma and his family members, Yudhishthira’s transition is ‘ordained.’ He may have side-stepped causality, the attacks of personified Death, the fear of Death and death, the loss of senses and breath and even the sloughing off of the body that accompanies a typical death, but Yudhishthira is bound by fate, or the predetermination of the Ordainer, even if the end result is a fortunate one.

In closing, after establishing various themes that come with death in both epics, and the various types of voluntary deaths in each, looking at the religious voluntary deaths of the heroes of both the Rāmāyaṇa and the Mahābhārata has shown some variation in the process of such deaths between and within each of the epics. In each case grief motivated the players, and yet fear did not seem present. Nor did the dreaded Lord of Death make an appearance in either epic with the voluntary death of the heroes. Rāma and Yudhishthira both attained embodied ascension, apparently without the loss of senses, breath or a dissolution process. Yudhishthira’s was fated, Rāma’s not. We can say that they transcended death. The remaining Pāṇḍavas, however, did not have embodied ascension nor transcend death, and so the loss of breath and dissolution most likely came with death but further investigation is needed to know whether they had delirium or not. The time of their moment of death was determined by causality, based on former actions. They were reunited, all.

Endnotes

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[i] Young 1989

[ii] Ibid.; p.75

[iii] Śreyas 2007 pp.293-303; Young 1989 p.75.

[iv] White 2009; p.114.

[v] Pollock 2006; p. 41.

[vi] Ibid. ; p. 135.

[vii] Ibid.; pp.137, 149, 281.

[viii] Goswami 2002.

[ix] English Pali Dictionary 2010.

[x] Berzin 2006.

[xi] Ibid.

[xii] Ibid.

[xiii] Pollock 2006; p.41.

[xiv] Ibid. ; pp. 47, 191.

[xv] Ibid. ; pp. 173, 179.

[xvi] Ibid. ; p.133.

[xvii] Ibid. ; p. 163.

[xviii] English-Sanskrit Mico-Dictionary.

[xix] Bhaktivedanta VedaBase Network.

[xx] Pollock 2006; p. 153.

[xxi] Ibid. ; p.281.

[xxii] Ibid. ; pp. 273-274.

[xxiii] Ibid. ; p.279.

[xxiv] Dutt 1892; p.1919.

[xxv] Pollock 2006; pp. 87, 221, 389.

[xxvi] Ibid. ; p.145.

[xxvii] Ibid. ; p. 41.

[xxviii] Ibid. ; p.385.

[xxix] Ibid. ; p. 227.

[xxx] Ibid. ; p.179.

[xxxi] Ibid. ; p. 183.

[xxxii] Ibid. ; p.373.

[xxxiii] Ibid. ; p.373.

[xxxiv] Ibid. ; p.375.

[xxxv] Dutt 1892; p.1914.

[xxxvi] van Buitenen 1975; p.574.

[xxxvii] Ganguli; Santi Parva [book 12], Section CCXVII.

[xxxviii] Ibid.

[xxxix] Yogananda 1973; p.22.

[xl] Ganguli; Santi Parva [book 12], Section CCXVII.

[xli] Ibid.

[xlii] van Buitenen 1975; p.575.

[xliii] Ibid. ; p.756.

[xliv] Ganguli; Santi Parva [book 12], Section CCXVII.

[xlv] van Buitenen 1975; p.742.

[xlvi] Ibid. ; p.733.

[xlvii] Ibid. ; p.272.

[xlviii] Ibid. ; p.576.

[xlix] Ibid. ; p.575.

[l] Pollock 2006; p.91.

[li] van Buitenen 1975; p.575.

[lii] Śreyas 2007.

[liii] Pollock 2006; p.55.

[liv] Śreyas 2007; p.296.

[lv] Exotic India 2010.

[lvi] Pollock 2006; p.61.

[lvii] Ibid. ; p.409.

[lviii] Śreyas 2007; p.296.

[lix] Ibid. ; p.295.

[lx] Dutt 1892; p. 1924.

[lxi] Śreyas 2007; p.296.

[lxii] Ibid. ; p.296.

[lxiii] White 2009; p.114.

[lxiv] Ganguli; Anusasana Parva [book 13], Section CLXVIII.

[lxv] Dutt 1892; p.1923.

[lxvi] Ibid. ; p.1923.

[lxvii] Ibid. ; pp. 1924-1925.

[lxviii] Ganguli; Anusasana Parva [book 13], Section CLXVIII.

[lxix] White 2009; p.114.

[lxx] Ibid. ; p.114.

[lxxi] Dutt 1892; p. 1925.

[lxxii] Ibid. ; p. 1927.

[lxxiii] Ibid. ; p.1929.

[lxxiv] Ibid. ; p. 1930.

[lxxv] Ganguli 1883.

[lxxvi] Ibid.

[lxxvii] Ibid.

[lxxviii] Ibid.

References

Berzin, Alexander (2006); The Four Maras (The Four Demonic Forces); The Buddhist Archives of Dr. Alexander Berzin (2010); http://www.berzinarchives.com

Bhaktivedanta VedaBase Network, Sanskrit-English Dictionary; The Bhaktivedanta Book Trust International, Inc.; http://vedabase.net/

Dutt, Shri Manmatha Nath (1892); The Ramayana; Girish Chandra Chackravarti, Deva Press; Calcutta.

English-Sanskrit Micro-dictionary; India (damaged; publisher and date unknown)

Exotic India 2010 http://www.exoticindiaart.com/product/OP95/

Ganguli, Kisari Mohan (translator, published between 1883 and 1896); The Mahabharata of Krishna-Dwaipayana Vyasa; Internet sacred text Archive; 2010, John Bruno Hare. http://www.sacred-texts.com/hin/maha/index.htm

Goswami, Srila Rupa (2002); The Demon Shankachuda (From Lalita-mādhava-nā akam); Sri Krishna Kathamrita Bindu magazine; Gopal Jiu Publications, Issue No. 34.

Pollock, Sheldon L. (tr., 2006); The Rāmāyaṇa Book Three, The Forest, By Valmiki. New York University Press.

Śreyas, Dr. D.S. Baya (2007); Samādhimaraṇa - Death With Equanimity: The Pursuit of Immortality; Prakrit Bharati Academy, Jaipur.

van Buitenen, J.A.B. (Ed., 1975); The Mahābhārata Book III, The Book of the Forest. University of Chicago Press. 1975.

White, David Gordon (2009); Sinister Yogis; Chicago; London: The University of Chicago Press.

Young, Katherine K. (1989); Euthanasia: Traditional Hindu Views and the Contemporary Debate; Hindu Ethics: Purity, Abortion, and Euthanasia; Albany, State University of New York Press.

Health Care in the Tibetan Refugee Community of Dharamsala (Kangra District, Himachal Pradesh, North India)

Sean Hillman, 2011
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 Tibetan Refugee Community in Dharamsala, India: Background

After going into exile in 1959, due to the heightening oppression of the occupying Chinese Communist regime in Tibet, His Holiness the Dalai Lama was followed to India by approximately 80-100 000+ Tibetans. According to the International Institute for Sustainable Development (IISD), “[t]he beginning years were expectedly the most difficult. Many Tibetans, coming from the high Tibetan plateau, succumbed to tropical diseases and heat. They were divided into road construction groups and lived in tented camps. With help from the Government of India and others, 54 agricultural and agro-industrial based refugee settlements were gradually established. The idea was to resettle the Tibetans in compact homogeneous communities where they would be able to preserve and perpetuate their culture and traditions, while at the same time enabling them to become self-sufficient in livelihoods.”[i] The majority of Tibetans settled in the Karnataka State of South India. There, the landscape is very flat, and this with the heat and drought make it as unlike their homeland as can be. Agriculture also proves to be quite difficult. The most significant of the many Tibetan communities throughout India, however, is in Dharamsala, a beautiful “hill station lying on the spur of the Dhauladhar range [of the Himalayas and]…wooded with oak and conifer trees and snow capped mountains [which] enfold three sides of the town while the [Kangra] valley stretches in front.”[ii] An environment much more suited to the Tibetans “lying 526-km northwest of New Delhi, Dharamsala[, it] is the headquarters of the Kangra District in the Indian state of Himachal Pradesh,”[iii] is the seat of the Tibetan Government-in-Exile, and houses the residence of His Holiness the Dalai Lama. The presence of the Tibetan leader and the region’s beauty, some parts so highly elevated (between 1250 m to 1550 m)ii that one is literally in or above the clouds, bring a myriad of Indian and foreign tourists every year. Birds of all kinds enjoy the area too, as it is a major migration route. Most of the settlement is built on steep inclines, and is subdivided into: (1) an upper region of Tibetan institutions (such as the Tibetan Institute for Performing Arts, TIPA), residences and markets called MacLeod Ganj which ends slightly further down the mountain at the main Temple complex and the Dalai Lama residence (surrounded entirely by a circumambulation route); (2) a mid-region even further down where the Central Tibetan Administration (henceforth referred to as CTA) offices (including the Paliament-in-Exile and Department of Health, henceforth referred to as DoH) and Library of Tibetan Works and Archives (LTWA) research library can be found; and (3) a lower region of Indian residences, offices and markets which splits off towards the Lower Tibetan Children’s Village school in one direction, and towards the Kangra Valley in the other. For the convenience of our purposes here we will subsume the entire area under the name “Dharamsala.”

What is provided collectively? What types of health care goods, other social goods & consumer goods?

Having provided some necessary background to the Dharamsala Tibetan settlement, we can now look at the goods available to the refugees. Let’s divide them broadly into the necessities of life (water, food, clothing, shelter, electricity), and essential services such as refugee intake and placement, health care, security, sanitation, education and transportation. Of course, many of these fall under Daniel’s categories of “[h]ealth-care needs…[which are] those things we need in order to maintain, restore, or provide functional equivalents (where possible) to, normal species functioning…[and which] can be divided into (1) adequate nutrition, shelter; (2) sanitary, safe, unpolluted living and working conditions; (3) exercise, rest, and other features; (4) preventive, curative, and rehabilitative personal medical services; (5) non-medical personal (and social) support services.” [iv] Looking at this list, we will add recreation to ours (including exercise and entertainment), and we will look particularly at medical (allopathic and traditional) health care and treat it separately.

The Tibetan refugee community in India almost entirely depended on the kindness of the Indian government when they first arrived in 1959, physically and emotionally destitute. “With help from concerned governments, the UN High Commission for Refugees, humanitarian organisations, and philanthropic individuals on the one hand and the sheer tenacity of the Tibetans themselves on the other hand,”ⁱ over the next 50 years an infrastructure has been built on the basis of a “democratic administration in exile…to manage the affairs of the Tibetan refugees” ⁱ to the point where the Tibetan community in Dharamsala has become autonomous and self-sufficient to a very high degree. Some of the goods mentioned above are provided/regulated by the Indian Government, some are collaborative between the Tibetan and Indian communities, and some are entirely provided by Tibetans for Tibetans. Some of the necessities of life are only available through the Indian governmental agencies, such as those which regulate water and electricity/gas distribution. A certain amount of land was initially given to the Tibetans, but building in other areas requires both permission from the government and collaboration with Indians since non-Indians cannot own land in India. An exmple of such a negotiation is the process of acquiring land in an area close to Dharamsala for another important Tibetan religious leader, His Holiness the 17^th Gyalwa Karmapa. Although the mountainous terrain of Dharamsala prevents the Tibetans from engaging in much agriculture, they do produce their main staple from ground barley, known as tsampa. Many goods are also brought from Tibet, such as bricks of tea, yak jerky and dried cheese. As expert crafts people, the Tibetans make much of their own traditional clothing, and sell them, as well as generating income by way of tourism and hospitality, crafts such as carpet weaving, wood and metal carving and sculpture, thangka (religious iconography) painting, book publishing, and traditional Tibetan medicine. This income allows for the purchase of food and clothing they cannot produce themselves, individual roof-top water tanks (beyond that which is available communally, such as the water that comes from local water-pumps) and electricity/gas supply.

As for essential services, the only areas where the Tibetans are for the most part dependent on the Indian government are security and transportation. Although there is a private security force surrounding the Dalai Lama at all times, which is reasonable for someone who is considered to be like a head of state (despite there being a democratically elected prime minister and parliament of Tibet-in-exile), the police and military are Indian-run. Although many Tibetans own private vehicles, including a great many motorcycles for their convenience and cost-effectiveness, the bus services (save some Tibetan-run tourist buses) and taxis are state-controlled. The remaining essential services, refugee intake and placement, health care, sanitation, and education, are collaborative overall, but Tibetan health care and education are predominantly internal within the Tibetan community. When Tibetans arrive from Tibet, exhausted, impoverished, frost-bitten from walking over snowy mountains and sometimes at death’s door, the Tibetans have everything in place to assist them (including a Tibetan Torture Survivors Program, TTSP, a “multi-disciplinary program…[to] reduce physical, psychosocial and psychological problems as a result of violence and politically motivated torture in prisons in Tibet”)[v], but eventually the new refugee will need to get permission to stay from the local police superintendent. There are identity papers that a Tibetan may acquire from the Indian administration, but they are not the equivalent of our landed immigrant documents. They may potentially be sent back to Tibet, but this does not happen as frequently as in Nepal since India does not relent to bullying by China whereas Nepal is heavily influenced by the regime. Tibetans even have the freedom to protest the Chinese occupation in India, but in Nepal it is forbidden (which I learned the hard way when I was arrested in Kathmandu in 1996 for being on a bus that was merely heading towards an Amnesty International sponsored rally). As for education, “[w]ith assistance from the Government of India, Tibetan schools were established to impart modern secular education to the Tibetan children while also emphasising the learning of Tibetan language and literature, history, culture, religion, arts and crafts,”ⁱ and now it is safe to say that there are no Tibetan children not attending one of the Tibetan Children’s Village schools (which also serve as orphanages). In theory, the Indian government schools are open to Tibetans, but that option is not usually taken. Tibetans also have the option to attend secondary and post-secondary institutions, such as the College for Higher Tibetan Studies (where I had the fortune to studied logic and philosophy in the Institute of Buddhist Dialectics division). It is important to note that monastic community life and education is available as well, with more monastic colleges for males but still enough available for nuns to pursue such training also. Sanitation is an ongoing struggle for both the Tibetan and Indian administrations and communities. Both have made attempts to slowly develop recycling and garbage pick-up programs and install public washrooms in key locations, such as the main religious hub of the Temple complex of the Dalai Lama. Open sewers remain, as does the phenomenon of outdoor human waste elimination at the side of the road, or even during mass gatherings with the side of a hill demarcated in lieu of porta-potties. Garbage is still thrown into the environment, and collected waste is brought to open dumps at some distance from residential areas. Tibetans must pick up the slack in areas where the Indian government falters, and their recycling in the Tibetan institutions is quite admirable. The stray dog overpopulation problem, with rabies and mange quite rampant, is dealt with either by removing them to other areas, isolated sterilisation projects (such as volunteer Danish vets brought in the early 2000’s) and a relatively new animal welfare association. Lastly, touching briefly on recreation will suffice with mention of basketball courts being an essential part of every Tibetan school’s yard, and a public swimming pool built by the regional authorities at the site of a natural spring, which keeps the pool constantly full of fresh (and bone chilling!) water.

Next we come to health care. India has, in general, a two-tiered health care system. Both Indian government hospitals and private clinics exist, the latter including physicians, labs, diagnostic imaging, oncology and so on almost endlessly. Tibetans have access to both, but would sooner visit a traditional Tibetan doctor who approaches health with a 3-humours model, placing emphasis on pulse and urine analysis and including religious explanations and activities in response to health concerns. They may also simply buy herbal remedies, or blessed substances such as ‘mani pills,’ from the Tibetan Medical and Astrology Institute (TMAI, Men-Tsee-Khang). Both Men-Tsee-Khang and the Tibetan Delek Hospital are located mere steps away from the Central Tibetan Administration complex, and the hospital would be the next place to visit when addressing more serious conditions. The “45-bed…hospital provides general medical care with a special focus on Tuberculosis, the single most serious infectious disease that threatens the Tibetan population and new arrivals from Tibet. Delek also has strong maternal and child health care programs, a service sorely lacking in the area.”[vi] Since Delek’s “hospital services are limited to primary health care…as we cannot provide advanced medical facilities in our settlement hospitals due to lack of qualified and duly skilled staff and also because of financial constraints” patients are sometimes sent for “advanced…treatment in referral hospitals in various parts of the country…[hospitals] that cover major surgeries and other allied health services, which are currently not available in our settlement hospitals.”^v The hospital does have a single, small ‘ambulance,’ a converted van of the type used by local taxi drivers. A co-ed old age home for the Tibetan elderly, Jampa Ling, is located behind the residence of the Dalai Lama, strategically placed because it is on the circumambulation route around the residence and older Tibetans are quite fond of circumabulating for health and social chatting, in addition to the karmic merit that is thought to be accrued. At any point in the development of health concerns, from the most minor to the most major for oneself or a loved one, a Tibetan may also consult a religious professional (either monastic or not). In addition to astrological advice that can also be accessed at the Men-Tsee-Khang, a client may ask for: a divination (by dice, tsampa balls, or drum); an assessment for potential spirit harm as the cause of disease or obstacles; or even an exorcism (though this is less frequent in contemporary India, or kept more quiet). The Central Tibetan Administration’s Department of Health is “working towards the integration of traditional system of Tibetan medicine with the allopathic Primary Health Care system in order to avail maximum benefits. The two systems of medicine run in parallel to each other and are used equally by the people; increasing the frequency of referral process between the two health care systems.” ^v It has also, over the years, implemented programs for: potable water, improved sanitation, substance abuse rehabilitation, helping those with disabilities and special needs, and health education including HIV/AIDS campaigns.^v

The nature of the provision for each of these types of goods.

Upon arrival to India as refugees, the Tibetans lived in tent camps and the basic necessities of life were provided for by the Indian government. Since then, the Tibetans in Dharamsala have become organized enough to not have to rely entirely on the generosity of India and can afford the costs of individual household water-lines/tanks (although some families still access local unfiltered well-water via pumps, which are unreliable at best but available at no cost) and electricity, food and clothing (so much so that new refugees can be taken care of by the community) and land beyond the areas initially given to the Tibetans. Although private taxi-drivers and tour buses abound, generally bus and taxi transportation service and fees are regulated by the government which makes for low ticket prices and reliable schedules. The extra efforts to improve sanitation in Dharamsala are borne by the community and donations from abroad. Almost every area of Tibetan society is in some way touched by international financial support, but predominantly it is found in support of: refugee services, education, environment (sanitation, roads, building), monasteries/nunneries and health care. As mentioned earlier, Tibetans can access free education and health care provided by the Indian government but mostly opt out in favour of Tibetan-run services. Education and health care are two areas where needy Tibetans can get what they need at no cost, but, in addition to international donations, the Tibetan community itself bears the financial burden to some degree.

The Tibetan Children’s Village is a case-in-point regarding the Tibetan community investing in education to ensure access and quality. “On 17 May 1960, fifty-one children arrived from the road construction camps in Jammu, ill and malnourished. Mrs. Tsering Dolma Takla, the elder sister of His Holiness, volunteered to look after them. Initially these children were assigned to members of the Dalai Lama's entourage, but before long the Government of India offered its assistance, renting Conium House to accommodate all the children together… Originally, the Nursery for Tibetan Refugee Children provided only basic care for children. When they reached the age of eight, they were sent to other residential schools established by the Government of India. But eventually this arrangement could not be continued as all the residential schools filled to capacity… A massive re-organization plan was set into motion. This included seeking help from private donors and international aid organizations. A period of hectic construction work ensued to provide for more houses and classrooms for children. The Nursery slowly took the shape of a small village with its own school and homes… [Started in the 80s during a great influx of refugees, t]oday, TCV School Lower Dharamsala is a high standard school with both primary and secondary school. It is entirely funded by Tibetan parents in exile.[vii] Initially the Government of India provided both land for refugee orphan housing and access to Indian schools, but proving inadequate, the growth required depended instead on international support and eventually the Tibetans could support their main school themselves. The monastic life, too, is invested in by both international supporters and the Tibetans-in-exile such that any Tibetan who can follow the discipline can be assured of a lifetime of support by the institution. This includes the necessities of life and extensive religious (and some secular) education.

Health care is another example of a good invested in by both international supporters and the Tibetans-in-exile themselves to ensure access and quality. It is free for both Tibetans and local Indians who cannot afford the low fees. “In its basic health care policy, the DoH has adopted the goal of ‘Health For All,’” ^v and as an example, Delek Hospital is a charitable institution where “[u]ser fees are kept exceptionally low so that the poor can afford treatment in this hospital.”^vi The CTA is responsible for maintaining free access to health care for the poor: “Under the guidelines issued by the Kashag (Apex Executive Body), the Central Poverty Alleviation Committee has conducted an intensive survey on poor and needy among the exile Tibetan Community… As per the Kashag’s policy and guidelines, the Department of Health is providing monthly stipend and bearing all the medical expenses of all the needy and poor Tibetan people identified by the Central Poverty Alleviation Committee.” ^v An Emergency Medical Relief Program allows for Tibetans to pay what they can (even if it is zero), and to buy into health insurance: “advanced treatment…can be classified into two categories: emergency medical relief for the staff members of Central Tibetan Administration who make a monthly contribution of 1% of their monthly gross salary towards CTA medical fund. The other category is the poorest of the poor who are selected and duly registered by the three concerned CTA Departments, i.e. Department of Home, Education and Health. We look after the health of the poorest of the poor category and bear cent per cent of their medical cost including medical services, surgery and other operational cost. As for the remaining category of patients, the percentage of DoH medical relief assistance is based primarily on the scrutiny and recommendation of the settlement heads, camp leaders and the DoH hospital Executive Secretaries of various settlements.” ^v

What types of health care goods are and are not provided collectively (or where the type of provision is different)?

There is a difference in the distribution of Tibetan traditional medicine and the operation of freelance religious professionals that address health concerns by way of traditional medicine or by religious methods. The Tibetan Medical and Astrology Institute (TMAI, Men-Tsee-Khang) supports their own staff and their families, and students from funds generated by their services and from international support. “To involve children in the community of TMAI, housing, child care and other resources are provided to staff and their families. To ensure that the children of staff receive adequate medicine, food, clothing and school supplies, we seek individuals willing to sponsor a child… As part of its charity work, Men-Tsee-Khang also provides free education for its medical and astrological students.”^viii Additionally, the elderly, new refugees, the poor, monastics and students are granted special consideration: “Charitable Health Care: As a registered charity, it is Men-Tsee-Khang policy to provide free medicine to Tibetans over the age of seventy, to new Tibetan refugees for the first six months, and to poor or desitute Tibetans (the respective Settlement/Welfare Officer in the refugee settlement determines whether a Tibetan is poor or destitute). Concessional medicine is provided to monks, nuns and students.”[viii] It is noteworthy that the last category of Tibetans are not given free medicine, but rather that which is “concessional” (some degree of subsidy), likely because the institutions to which they belong provide on-site medicine and basic nursing care, monetary support for health care external to the institution, and monetary stipends. It is also worth noting that the elderly are given free medicine regardless of their financial standing.

As freelancers, religious professionals control the distribution of their own services. As they may or may not be monastics, they may or may not be receiving financial support from a monastic institution or individual lay Buddhist devotees. As a dependent themselves, it would be difficult for a monastic to deny helping someone who could not afford their services but as there is no regulation of their vocation as a healer, herbalist, diviner, astrologer, exorcist or ritual specialist, their own discretion determines how they deliver services. If they are a graduate of the Men-Tsee-Khang, as many monks are in fact trained traditional Tibetan medical doctors, there may be some systemization of their delivery of service despite having their own clinic. This requires further investigation.

What rationale(s) is provided (or implied) in all of this? What appears to be the nature of the entitlement(s)?

Here we have several types of distribution: the Indian governmental support of the Tibetan refugee community, Tibetans helping other Tibetans, Tibetans investing for entitlements for themselves and the younger generation, Tibetans helping the impoverished regardless of their ethnicity, and Tibetans giving special entitlements to certain groups within the Tibetan community: new refugees, the elderly, the destitute, students, and monastics.

As for the initial and ongoing Indian governmental support of the Tibetan refugee community, I think there are several layers of rationalization behind it. The first could be the particular situation of the Tibetans as refugees. As such, they are particularly needy, disadvantaged and unprotected. Not only this, they are a neighbouring people who consider India as their spiritual homeland from which their religion has come, as the majority of Tibetans are Buddhists who practice Indian Buddhism (as opposed to Chinese Buddhism). Plus, India is sympathetic to the Tibetan cause in opposition to the Chinese communist viewpoint that Tibet is a part of China therefore their occupation is legitimate. This is shown by 50 years of India not bowing to Chinese pressure to not host the Tibetans, and could be reinforced by the fact that India has had its own troubles with China where their borders meet. For both the Indians and Tibetans who are in a position to help new refugees, both can see them as special claimants, and be motivated to meet their needs because they are especially needy. They may also be motivated to prevent harm, and also driven by charity and beneficence. The reasoning of fulfilling the needs of others by virtue of their being special claimants can also be behind the Tibetans’ demarcation of certain groups: the poor in general, and the elderly within their own community. These groups are vulnerable and especially needy, and so helping them can be motivated by the same reasoning as for helping refugees (harm prevention, charity, beneficence). Alternatively, the students and monastics would not have special entitlements because of being especially needy and vulnerable, but rather due to their particular lifestyle requiring them not to work and the value placed on these groups by Tibetan society. Students, in order to fully participate in society as a wage-earner, need to spend a certain amount of time focusing on their studies and not working. Similarly, but in an ongoing way, monastics need to focus on their religious studies and practice and in observing the ascetic discipline they do not do wage-earning work in that trade or commerce increases attachment to wordly activities and possessions. Highly revered in Tibetan culture, the role of a monk is in reciprocity with the Buddhist householders: the monastics offer teachings and guidance, and the householders support them by providing the requisites of food, shelter, clothing and medicine (either directly or by way of making donations to the monastery/nunnery). It would be remiss to not mention that Buddhists see any help offered to monastics as one cause for the accumulation of meritorious karma that will benefit the practitioner in this and future lives, so religiously-oriented motivations also influence entitlements granted monastics. Lomasky’s statement that “[e]ven on coldly economic grounds, it is irrational not to invest a sum that will be returned many times over in a life of increased productivity” [ix] can apply to the entitlements given to refugees, students and monastics. Even though wage-earners and non-wage-earners have different outputs from their training and development, both are valid and valued by Tibetan society for their contributions. As well, both refugees and students will eventually, it is hoped, no longer be at all dependent on special entitlements and so their initial and limited supported can be seen as the fair equality of opportunity principle in operation.

According to these policies and practices, is health care different? How is health care different?

Buchanan’s approach of using the “combined weight of arguments…[as] justification for an enforced principle guaranteeing a decent minimum of health care to everyone…[rather than a] universal right to a decent minimum of health care”[x] might give us a glimpse at the reasoning behind the Indian government and the Tibetan community in India treating health as paramount in refugee support. The first are the “Arguments from Special Rights^ix where “[s]pecial right-claims…restrict the right in question to certain individuals or groups."[xi] One type of these arguments is "from the requirements of rectifying past or present institutional injustices… on the grounds that these injustices have directly or indirectly had detrimental effects on the health of the groups in question...[from a] history of unjust treatment by government or other social institutions."^x The Tibetans as new refugee claimants escaping from an oppressive regime certainly makes them an especially needy group health-wise, suffering from such things as: injuries, malnourishment and post-traumatic stress from torture, underlying illnesses exacerbated by not receiving proper care in Tibet, frost-bite from the trek to India and so on. The legitimacy of the claim is strengthened by India’s first-hand experience with China’s strong territorial movements to surrounding areas. In this case, the rectification would not be because of injustices perpetrated by India, but rather those perpetrated by the occupying Chinese and recognized as such by India. Another line of reasoning comes from Buchanan’s “Arguments from the Prevention of Harm” which will "protect the citizenry from certain harms arising from the interactions of persons living together in large numbers… Examples include sanitation and immunization. The moral justification of such measures, which constitute an important element in a decent minimum of health care, rests upon the widely accepted Harm (Prevention) Principle, not upon a right to health care." ^x Since the Tibetans have, at various times (particularly 1959 and the mid-80s), come to India in droves, such a principle would inform the actions of the hosting nation in relation to refugees to ensure not only that the Tibetans would not be harmed by being put together while their susceptibility to illness is high (taking as a given that the majority will not be in good health upon arrival), but also so that Indians in the surrounding areas will also not be harmed by the spread of disease out from the refugee community.

Earlier it was shown that education and health care are the two social goods that Tibetans buy into for themselves: Lower TCV school is entirely funded by Tibetans, and some Tibetans have the option to give a percentage of their income as health insurance. Health care is approached differently in that it relies on support from the CTA and donations both local and abroad and a sliding-scale based on the ability to pay because (1) the needs are so great and, because (2) the Tibetans are committed to providing health care to every Tibetan. It cannot be said that the Tibetans ensure that every Tibetan gets an education, since it is only for Tibetans of schooling-age that this is done. But it can be said that the Tibetans ensure access to health care for every Tibetan.

A major influence on the Tibetans treatment of health as special comes from the Buddhist conception of suffering and its alleviation as the fundamental human challenge. When Daniels says that “[s]ome might say health care in a direct and simple way reduces pain and suffering,”[xii] the Tibetans would belong to this group. There are many principles from Buddhist doctrine and practice that might influence Tibetan decision-making: generosity, the wish to benefit others, the wish to become fully developed in order to be most effective in helping others do the same, love (the wish for others to have happiness), compassion (the wish for others to be free from suffering), the technique of imagining taking on other’s suffering and giving them happiness in return, and so on.. All of these can be engaged in with the idea of accruing karmic merit for oneself or, alternatively, with no hope for reward, purely for the sake of the other. With these as a foundation, an “enforced beneficence argument for a decent minimum of health care”[xiii] might not be seen as interference in a person’s autonomy but rather as a co-ordinated effort to act in accord with Buddhist principles as a group which must necessarily lead to a positive outcome.

It might be said that Tibetans overemphasize health. This, however, might be perceived by an observer as due to the Tibetans’ not holding to a “ ‘biomedical’ model of disease and health…[where health is the] absence of disease…[and illness is from] deviations from the natural functional organization of a typical member of a species.”[xiv] Tibetans, rather, adhere to a bio-psycho-spiritual view of health, which means that many things are included that would not be typically seen as falling under the binary of health/disease, such as very subtle conceptual positions and emotions. Also, contrastingly, because the end goal of the Buddhist path is seen as total mental health (which will necessarily be coupled with perfect physical health), a heavy emphasis is placed on mental development to the detriment on some crucial components of health, such as exercise.

Are these policies and practices appropriate?

The historical support of the Tibetans-in-exile by the Indian government in providing refuge, the necessities of life and essential services up to the point where the community could support themselves, to the detriment of the country’s relationship with China, is very admirable and garners ongoing gratitude from the Tibetans. Treating refugees as a special group, especially when most have been subject to abuse, is appropriate, as is harm protection for the Tibetans as a group and in relation to pre-existing neighbouring communities. The Tibetans utilize these two principles (special entitlements and harm protection) themselves when dealing with new refugees. The only problem is see with this is in finding the threshold where a new refugee is no longer ‘new’ and has achieved a certain level of stability where his entitlements should change because they require less dependence. The Tibetans make this distinction, but I do not know how they come to the determination that a refugee is no longer ‘new.’ I also am not sure how or if the Indian government makes the distinction between a new or more settled refugee. My concern extends to the support given by international donors and fundraisers. For example, in South India some monastic institutions receive monetary support beyond their needs and, in the expressed opinion of the Dalai Lama, it is wasted on buildings that are too big to fit all of their monks and would be used more effectively if given to the local farmers who struggle with drought. Also, in every Tibetan community in exile there will be some who try to retain multiple sponsors, on the basis of being a refugee and each without the knowledge of the others, and resulting again in there being resources beyond needs. The potential to subsume new refugees with those that are more settled, and the accumulation of benefits and donations from multiple sources, can endanger entitlement claims as well as charitable assistance.

In my opinion, the biggest concern with the reasoning behind health care provision in the Tibetan refugee community in Dharamsala is the lack of some degree of personal responsibility affecting distribution. As Gutmann states, when we consider the various “choices of lifestyle among the population[xv]…[a]n equal access principle seems to neglect the distinction between voluntary and nonvoluntary health risks…”[xvi] The Tibetan community is notorious for certain types of behaviour statistically leading to certain health outcomes: a diet relying heavily on butter and salt, leading to high prevalence of diabetes; snuff usage, even (maybe even especially) in monastic community, leading to nasal problems and cancer; long periods of meditation while immobile in meditation retreat boxes causing crippling joint problems; lack of exercise in monasteries leading to obesity and heart problems;

and some may point to almost perpetual usage of incense as a risk for sinusitis. Not unique to the Tibetans, of course, but alcohol and drug abuse are problems particularly among new and young Tibetan refugees. Like Gutmann, in this community where access to health care is guaranteed for all, I would “…ask whether it is fair to provide the same level of access for all people, including those that voluntarily adopt bad health habits, and who quite knowingly and willingly take greater-than-average risks with their lives and health.”^xvi The question is: are Tibetans all able to recognize certain activities as health risks? I agree with Dworkin (1979), quoted by Gutmann, who states that it would “not be unfair to force individuals to be financially liable for voluntarily undertaken health risks, but only under certain conditional assumptions…[the] ability…1) to determine…causal role of voluntary versus nonvoluntary factors in genesis of illness; 2) to differentiate between purely voluntary behaviour and…compulsive; and 3) to distinguish between genetic and nongenetic predispositions to illness.”[xvii]

If it is determined that a behaviour that is a risk to health is voluntary, the question then becomes: what health care entitlements are owed to this Tibetan by the Tibetan community, as decided by the CTA DoH? This is a difficult question in the context of a community committed to “health for all.” I would, however, suggest some new methods of health education and some deterrents to behaviours that pose health risks. Until now, according to the DoH, health education has been limited to “various health awareness programs in the settlements, schools and monasteries…[by way of] newsletters…pamphlets, books, comics, posters and films.”^v What education is done by health professionals at the bedside or in clinics? And do foreign volunteer health providers have the freedom to explore approaches to health that may have never been broached with a Tibetan before? As for risk behaviour deterrents, since threats to access would not fit the Tibetan “health for all” model, providers could discourage those who consciously engage in behaviour that risks health by: increasingly burdening them with accountability exercises; providing explicit reference to the strain on the community, caregivers and resources (cost per visit or procedure); and making them aware of the increasing barriers to their own ability to access health services that would come with deteriorating health (such as not being able to make it to the hospital in time when in crisis).

Notes

[i] International Institute for Sustainable Development (2011); We the Peoples: 50 Communities Awards (A summary of exemplary communities by category of UN activity); http://www.iisd.org/50comm/commdb/desc/d46.htm

[ii] Department of Tourism & Civil Aviation, Government of Himachal Pradesh, Shimla (2008); Himachal Tourish: Unforgettable Himachal; http://himachaltourism.gov.in/post/Dharamshala.aspx

[iii] An Informative, Travel and Community Website of Dharamsala, Mcleodganj and Kangra Valley (2011); http://www.mcllo.com/mcleodganj%20%5BMcllo.com%5D.html

[iv] Daniels, N. (1981); Health-care Needs and Distributive Justice. Philosophy and Public Affairs; Spring. 10(2): p. 158.

[v] Central Tibetan Administration Official Website (2009); http://www.tibet.net/en/index.php?id=25&rmenuid=12

[vi] Friends of Delek Hospital (2010); http://www.delekhospital.org/index.htm

[vii] Tibetan Children’s Village (2004); http://www.tcv.org.in/

[viii] Men-Tsee-Khang: Official Website of the Tibetan Medical and Astrology Institute of H.H. the Dalai Lama (2011); http://www.men-tsee-khang.org/

[ix] Lomasky L. (1981); Medical Progress and National Health Care. Philosophy and Public Affairs. 1981; 10(1): p.85.

[x] Buchanan, Allen E. (1984); The Right to a Decent Minimum of Health Care; Philosophy and Public Affairs, Vol. 13, No. 1, Princeton University Press. p. 66.

[xi] Ibid.; p.67.

[xii] Daniels 1981; p.169.

[xiii] Buchanan 1984; p.76.

[xiv] Daniels 1981; p.155.

[xv] Gutmann A. (1981); For and Against Equal Access to Health Care. The Milbank Memorial Fund Quarterly. Health and Society; 59(4): p.553.

[xvi] Ibid.; p.554.

[xvii] Ibid.; pp.554-555.

References

An Informative, Travel and Community Website of Dharamsala, Mcleodganj and Kangra Valley (2011); http://www.mcllo.com/mcleodganj%20%5BMcllo.com%5D.html

Buchanan, Allen E. (1984); The Right to a Decent Minimum of Health Care; Philosophy and Public Affairs, Vol. 13, No. 1, Princeton University Press.

Central Tibetan Administration Official Website (2009); http://www.tibet.net/en

Daniels, N. (1981); Health-care Needs and Distributive Justice. Philosophy and Public Affairs;

Spring. 10(2).

Department of Tourism & Civil Aviation, Government of Himachal Pradesh, Shimla (2008); Himachal Tourish: Unforgettable Himachal; http://himachaltourism.gov.in/post/Dharamshala.aspx

Friends of Delek Hospital (2010); http://www.delekhospital.org/index.htm

Gutmann A. (1981); For and Against Equal Access to Health Care. The Milbank Memorial Fund Quarterly. Health and Society; 59(4).

International Institute for Sustainable Development (2011); We the Peoples: 50 Communities Awards (A summary of exemplary communities by category of UN activity); http://www.iisd.org/50comm/commdb/desc/d46.htm

Lomasky L. (1981); Medical Progress and National Health Care. Philosophy and Public Affairs. 1981; 10(1).

Men-Tsee-Khang: Official Website of the Tibetan Medical and Astrology Institute of H.H. the Dalai Lama (2011); http://www.men-tsee-khang.org/

Voluntary death as found in the epics Mahābhārata & Rāmāyaṇa

COMING SOON

Thoughts on the Rāmāyaṇa & Mahābhārata

COMING SOON

Short pieces on the great Indian Sanskrit epics Rāmāyaṇa and Mahābhārata.