Sallekhana or Suicide

 

images-2Several weeks ago, a prominent and beloved member of our community fell to his death from the 23rd story terrace of his downtown condominium.

I knew, without being told, that he had jumped. It seemed a horrific way to die, but I recoiled at the term “suicide,” with its connotation of an irrational action and a waste of human potential. At age 86, this man suffered from Lewy body dementia, a progressive disease that is a toxic blend of Alzheimer’s and Parkinson’s. Given his prognosis, it was hard to view his action as irrational.

“We need another word besides suicide,” noted a mutual friend, “for someone with a terminal illness who chooses not to prolong the suffering of chronic disease in old age.”

Shortly after that conversation, in one of those serendipitous coincidences that leave you breathless, I read an article entitled Sallekhanā is not Suicide. It is one of the readings for the class I’m teaching on how different religions deal with death and dying.

I had never heard of Sallekhanā (sa-lay-ka-na), although it has been around for more than two thousand years. This end-of-life ritual entails the gradual reduction of food and liquids until death occurs.

It is a core practice of the Jain community, a religious tradition that emphasizes non-violence and, like Buddhism, seeks eternal liberation from the cycle of life, death and rebirth. According to Jain texts, the term derives from the words sal (meaning ‘properly’) and lekhana (‘to thin out’). Sallekhanā is viewed as the proper thinning out of the body and its passions.

But it is not for everyone, as there are strict criteria for its use, among them that:

  • Death appears imminent from old age or incurable disease.
  • One is mentally competent and in “good emotional health” but has freed him/herself from the bodily passions and emotions (e.g., grief, fear, regret, affection, guilt).
  • Responsibilities to one’s family have been fulfilled, and permission has been granted by them and by your spiritual “master.”
  • One has practiced “fasting” (e.g., no food one day a week) for some time prior to taking the vow of Sallekhanā. After taking the vow, one simply increases the extent of the fasting regimen, with the gradual elimination of food and water.

Jain teaching is quite clear that Sallekhanā is a sacred ritual that is part and parcel of a religious life style. Any self-imposed death that involves violence or impulsive behavior in response to depression, grief, or incurable disease, would be labeled suicide, not Sallekhanā.

Clearly, Sallekhanā does not cover my friend’s decision to jump to his death. But it does bring into sharp focus the fact that, in our current culture, many treat death as something to be to be avoided or delayed if at all possible. Sallekhanā is based on the notion that death is an inexorable and desirable part of a life well lived … that one’s worth as a human being is not measured by the ability to “hang on” in the face of terminal illness and considerable pain.

What word would you use?

 

Comments

  1. I had never heard of Sallekhana. It ssems like a viable alternative to what you term “hanging on.” If it is indeed a sacred ritual and a nonviolent action, would like to look at it more deeply. Thanks for bringing it to my attention.

    • Mary Gottschalk says:

      Toni … thanks for stopping by … it is a very interesting ritual, and I don’t think there is any religious group besides Jains that practice it in so structured a way. There’s quite a lot of literature on it, in addition to the link in my blog.

  2. Mary, having watched my brother-in-law (Bob’s brother) die with Lewy Body dementia, a diagnosis given to a patient who still has any brain powers remaining to understand his/her disease or who knows the devastation ahead may likely do the very thing your acquaintance did. It is a horrible thing to watch, much less experience. Bob’s brother lived only 18 months, none of which had a quality of life any human would want.

    That being said, as you know, Oregon has a Death with Dignity Law, which is still highly opposed in some circles. I see it as a better alternative to the type of suicide you describe here or even Sallekhana. Suicide leaves family and friends wondering what they did wrong, filled with other questions, and the immediate trauma of a life cut short, yes even at 86. On the other hand, I see Sallekhana as a lengthier suicidal act depriving the body of its needs. It has to become painful as organs fail and die. Contrasting with suicide, Sallekhana is not immediate death as in the prior.

    You asked whatword we would use to describe end of life. As a Christian, my husband looks at it as the “next great adventure.” I tend to agree with him because I too am a Christian believing God brought me here, and it his right to take me away. However, I also strongly believe that we cannot know another’s pain or state of mind at the end of life, or where they are brought to define their own end of life and by what means. I suppose I would say choosing a single word is impossible, or to even choose a phrase to describe end of life. We haven’t yet experienced it other than the way Bob and I did.

    A reading of Being Mortal: Medicine and What Matters in the End by Atul Gawande sheds light on this question/issue from the medical point of view. I found his personal and professional approach to his patients with terminal illnesses and/or nearing the point of “there’s nothing more I can do” very refreshing. If you haven’t read, you might consider it.

    Thanks for this thought provoking and important post.

    • Mary Gottschalk says:

      Sherrey … Lovely to hear from you. I like your “next great adventure” as it puts a very positive spin on what happens after … but what I think I am searching for is a word that captures the act of terminating one’s life based on a decision process that is rational and well-thought out based on an attempt to balance between this adventure and the next one.

  3. Jeri McGinnis says:

    Thank you for sharing this Mary. It is indeed thought provoking as Sherrey said.

    Our family believes in personal quality of life … which can only be defined by the person experiencing it.
    The labor of death parallels the labor of life … A natural part of our world.

    How sad that the choices of birth, living & dying have become medical events involving law, legislation, insurance companies & liability coverage.

    Hopefully consumers will continue to be proactive and responsible for personal health/medical care choices in our communities.

    When life interrupts our plans, we are fortunate to still receive guidance from supportive & proactive medical care professionals.

    • Mary Gottschalk says:

      Jeri … thanks for taking the time to share your perspective … I completely agree that no one can define someone else’s quality of life … and that dying is, and should be, an important part of the experience of living. The problem with the medicalization of every part of life is that the human values … my experience, our experience together… get labeled in ways that make it harder and harder to experience our humanity. Sometimes it’s good, sometimes it’s bad, but it should be my right to decide how and when to consider that experience fulfilled.

  4. Susan Judkins says:

    My long-time family physician made the choice to stop eating, and I would say all of the other criteria had been met for hm. Thank you for sharing this information.

    • Mary Gottschalk says:

      Susan … thanks so much for taking the time to comment … I think you are so lucky to have shared in the experience of someone who made the dying process an integral part of living.

  5. What a thought-provoking post, Mary. I don’t know what word I would use. Sallekhana, as you describe it is interesting, but seems to place a burden on someone who might not want to fast and give up the body or feel that spiritual sense.

    When our old lady cat was finally very sick to the point she didn’t get up to eat, I knew it was time to end her suffering. Even though I cried and was sad, it was the easiest, most gentle death I’ve ever seen. I know people and animals are different, and I know there could be unscrupulous people who want to take advantage of sick people, and I know we don’t want our loved ones to go–but if I had the choice between a gentle easy death or being stuck with a body that I couldn’t control and a mind that didn’t function, or being in constant, incurable pain, I know which I would choose.

    • Mary Gottschalk says:

      Merril — I love the image of your cat and a peaceful dying. I have been told by friends in the medical field that when you are dying — when death is approaching— that digestion puts an unnecessary strain on the body’s systems …. that withdrawal of food and hydration does not cause suffering (as long as you keep the mouth and skin moist) and can ease the departure process. But if you haven’t lived through it, how do you really know?

  6. Pete Howell says:

    I thought this was really well done – I’ve never really understood the opposition to assisted suicide. Add that to the long of other things I don’t understand……

  7. Mary, first let me extend my condolences to you on the loss of this member of your community. All loss can be painful. I’m sorry.

    As you might know, I live in Vermont, which has just come through an extensive conversation on “death with dignity.” And I sing in a hospice choir. As such I have the privilege often to stand along the bedside of folks who are near death, occasionally being witness to the transition. And we do look at it as a transition. How can we not? One doesn’t need to believe in a specific life every after to see it as a transition, just as birth is. In fact, our director began her career as a midwife and often makes the point that she is just completing the cycle of witnessing life at its two most important transitions. We just don’t know what comes next, but I personally look at it as a “great adventure” solely because I don’t know. When pushed, I refer to my “tulip philosophy:” we die in autumn and come back in spring bigger and better. It’s winter that is the big mystery to me.

    I second Sherrey’s recommendation of Atul Gawande’s Being Mortal. He rails against the “medicalization of old age” but his arguments can be applied to the younger, terminally ill as well. As we all must learn, there is a time to fight and a time to cease from fighting and accept, even the unacceptable.

    Thank you for another provocative post.

  8. I TRULY LOVED THIS PIECE, MARY!!
    Louise Noun also committed suicide with the help of her friends…these two leaders in life will hopefully by their example, lead also by their deaths.

  9. Jeff Lawrence says:

    Mary: Great article. I believe there should be another choice besides waiting for the inevitable. I think we all hope to come to the end of life while having great sex, drinking fine wine or whiskey and smoking a good cigar . Living wild right to the end. However, like cancer, death and dying, especially prolonged dying, affects not just the dying or those diagnosed with cancer but also those who hold you close in heart and mind. They will have their own time, and should have the choice on how they want to go. My prolonged suffering should not be a burden they should carry. This is my opinion.

    Please keep writing great, thought provoking articles. Not many are intelligent enough to do so. Thank you.

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