ISJS Jainism Study Notes E5 Vol 03

Author(s): International School for Jain Studies
Publisher: International School for Jain Studies

Page 208

for a stroll in a wheelchair if they wish, but they may also stay in bed. Here, based on the acceptance and understanding of the imminent approach of death in a palliative care environment, choosing to engage in Jaina voluntary death practices such as taking any of the three types of fast-vows, such as to not take anything by mouth (bhatta-paccakkhāna) and also to not move beyond a certain area (ingini-marana), or to not move at all (paovagamana), would fit easily. The third aspect of the vows regarding receiving help from others might require negotiation. With bhatta-paccakkhāņa one can receive the full assistance of others, thus requiring no alteration of the delivery of personal care on the part of palliative caregivers. With paovagamana, however, one can receive no help from others. Standard nursing care for a patient who cannot move themselves requires them to have their position changed in bed at least every two hours. Also, incontinent urine and feces must be cleaned immediately upon detection. I have often been witness to cases where, after crossing a certain threshold in the dying process (which is often a dramatic change in respiration called 'cheyne-stoking' which resembles a fish gasping when out of water), the family and staff decide to not turn the person anymore. In fact, turning the patient may be enough of a disturbance to the body-systems to hasten death. Colloquially we refer to this as 'the last turn. Because death is so near at this point, the development of bed-sores from an unchanging position is no longer relevant. It could happen that the decision is made to stop turning someone and they linger, perhaps for days on end. This might be tricky because of the caregiver's habit and injunction to turn patients. Here, the Jaina tradition can offer a very good approach. It is recommended to not take final vows until it is sure there will be no improvement in one's illness or deterioration, because in the Jaina tradition vows once taken cannot be taken back. This is not the case during the stage of preparation for sallekhanā, before taking formal voluntary death vows. One finds this in the Ācārānga-sūtra.
"Subduing the passions and living on little food he should endure (hardships). If a mendicant falls sick,
let him again take food.23 "
But with vows there is no turning back.
"Occasionally, it may happen that a supposedly "fatal" illness undergoes remission or complete cure during the course of progressive fasting. In such cases the vows which have
29 Jacobi, Jaina Sūtras, Part-1 :p.75
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