July 21, 2019

Suicide by Santhara? I saw it going on.


By John Guy LaPlante

What is Santhara? Simple. Pulling the plug by refusing food.

Santhara sounds unusual, I know. I’m telling you about it because it—or something like it—is being used by more and more Americans. Santhara is unknown in the United States, but it has taken place in India among a small cult for centuries.

It’s big news there right now and that—and how the idea behind that—is why I’m bringing it up. Big news because a few months ago Santhara was said to be unconstitutional over there. It went all the way up to India’s Supreme Court. Which okayed it.

How come I know about it? Through my friend, Sulekh, a PhD mechanical engineer from India. He and his wife Ravi had come to the United States as part of the great brain from India then– doctors and engineers and other professionals bailing out for better opportunities in a better country. They made it to the U.S.—under great odds– and proudly became voting Americans.

Sulekh and Ravi are Jains. They practice Jainism, which is a very ancient religion – far older than Christianity. The Jains are a small minority in India – only 1% or so – but they are influential – tremendously influential. They have a far bigger role in India’s government and economy than their numbers would suggest. Sulekh and I had been friends for 10 years or so. Too complicated to go into details, interesting though they are.

Sulekh kept telling me, “John, someday you will come to India with me for a visit!” I thought it was just talk. Who wouldn’t? Well, it happened. Sulekh was going for a special reason. At that time there were about 40,000 Jains here in the U.S. All high-achievers. And he had been elected their national president and was going to India on a goodwill visit.

He planned to crisscross India to visit major Jain centers all over the country. And I was going to tag along. Can you imagine that? I’d be dunked into that exotic culture for six weeks. And think of the incredible sight-seeing along the way! He wanted to tell Jains what living in the United States is really like. He wanted to raise money for a chair in Jain philosophy and religion at a major American university.

He wanted to set up a bureau to make it easier for parents to meet and make arrangements for their children. Jains believe in arranged marriages. They believe that young people are driven by passion and superficial factors, such as looks. A crazy concept to us. We believe in falling in love. But as Sulekh reminded me more than once, consider our huge divorce rate! He and Ravi had met on the day before their wedding (“We believe that love will come”). And to my eye love did come to them.

I had never been to that part of the world so imagine my excitement, my curiosity, and my apprehension. Yes, apprehension. How would I do there under that culture shock? And it was a shock. I didn’t get to see another American or another Caucasian in all those weeks. And the strange customs I bumped into. We toured much of India.

It’s a big country and it’s surprising how many cities we traveled to. Mostly over the road, although a bit by train and one plane flight. We had a chauffeur driving us; unthinkable for us to do the driving–too dangerous. Time and again we passed wrecked cars and huge trucks, left by the road after a bad accident.

Sulekh gave talks in one city or town after another. I sat in on them, the only white man. It was all in Hindi. Just gobbledygook to me. But I got the gist. I attracted a lot of stares, believe me. We saw amazing things of course. Such as the great Taj Mahal and Gandhi’s home and incredibly ornate temples built centuries ago and sights we get to see only in National Geographic or TV. And of course the poverty and affliction—make that afflictions– that befall so many Indians.

But now, on to how I got to witnesss Santhara first hand. We visited an ashram and met Jain monks and nuns. Were told of an old nun who was in mid Santhara. Were led to her room. She was in bed. In her 80’s, I guessed. Conscious but very weak. A nun was sitting at her side helping her sip water. The old lady acknowledged us but could not speak.

Sulekh and Ravi were greatly touched though they understood Santhara. They spoke to her, of course. She said little. Not up to it. They chatted in low tones with her nurse. It was all very solemn. Again I understood nothing. Finally we tip-toed out.

Outside Sulekh explained to me that the old nun after long thought had decided her time had come to leave this world. So she was taking the next step. Santhara. It’s a concept completely moral, long accepted, in fact applauded by Jains. She wasn’t the first by far and wouldn’t be the last. Later, back in the U.S., Sulekh told me that she had gotten her wish. I was shocked, of course. Never heard of such a thing.

I always thought that we live on and on until we die. If we got old and very, very sick and went through great pain,that was our lot. Our lot until we died. That was the nature of things. Bottom line, suicide was unthinkable. A sin. Illegal. Shameful. You had to be crazy to do that. What I saw the old nun doing—so premeditated, so public, so mundane–was a totally new and troubling concept to me. But it did give me food for thought.

Some time later, back home. I had another experience quite similar. I was a great admirer of Scott Nearing. He was widely known as an economist, political scientist, writer of dozens of books, public speaker for decades, farmer, social activist, world traveler, father of the back to the land movement. A remarkable man, and so admirable. Walking to a different drummer in so many ways. Look him up on Google or Bing. You will be fascinated.

I was profoundly affected by a couple of his books, especially his “Living the Good Life—How to Live Safely and Sanely in a Troubled World.” Also by his remarkable wife Helen and some of her books.

Well, just short of his 100th birthday, after remaining vigorous till near the end, Scott Nearing decided it was time to go. Made that decision calmly, in full possession of his faculties. I’m not sure whether he had ever heard of Santhara although through books and travel he was grounded in many cultures and philosophies. Anyway, just as he turned 100, he acted. What did he do? He stopped eating. Soon took to his bed. Just like the Jain nun. And died in 18 days. Helen was at his bedside. And that gave me more food for thought.

Now, about a traumatic happening when I was 20 years old. My college roommate Gil and I got summer jobs as orderlies at Long Island Hospital. Not Long Island, New York. Long Island in Boston Hospital. I was a pre-medical student at Assumption College, largely because my mother wanted me to be a doctor. Gil was pre-dental. We got the job because Gil’s aunt was a head nurse there.

Long Island Hospital was an affiliate of the big Boston City Hospital. It was a huge complex of buildings. They were linked by tunnels because of the harsh winter winds. The only other thing on the island was a long-deserted fort. You could see the tall buildings of Boston, a 45-minute ferry ride away.

The hospital had some 3,000 patients, half substance abuse and half medical, nearly all indigents. The sick ones were there because of long-term illnesses terminating with death. At the end, most– those whose bodies were unclaimed–were buried right there in the potter’s field. They could see it plainly out their ward windows.

Gil and I were replacements for the professional orderlies on vacation. Bed-pan orderlies we were. We worked in separate wards on eight-hour shifts. Sometimes days, sometimes evenings. Men’s wards. Each with 16 patients. I covered two wards and so did Gil. A nurse covered half a dozen wards, maybe more, so we were mostly on our own. The care was good but basic. No dramatics.

All of us staffers lived there on the island. Again Gil and I shared a room. Once or twice a week in the evening we’d ride our tiny ferry into Boston. Lots of fun. On the island, for recreation we’d walk down to the pier and watch the active harbor traffic.

Our jobs were to do whatever we could to help our patients. We served them their meals at their beds, lined up in two long rows. We had curtains we could draw between them for privacy when necessary. Some could get up and walk a little, or sit in a chair by their bed. Impossible for others. We’d change their sheets. Put them into fresh johnnies, or set them on a bedpan or take them off. We had to spoon-feed some. Cut their hair, shave them, cut their finger nails and toe nails.

Bathe them in the tub or help them shower if they were not up to all that themselves. Some could make it to the toilet. Others could not but didn’t need a bedpan. So we’d wheel them over, lift them onto the toilet, then lift them up and wipe them, then get them back to bed. Very demeaning and humbling for patients, for sure, though they got use to it. Or so it seemed. Very sobering for me and Gil.

A man died one evening. My third day on the job. I was alone. Had never seen someone die. What, what to do? I called a professional orderly on duty in another ward. He came with a gurney, closed the curtains around our patient—though all the other patients were aware of what was going on. They had seen this before. One day it would be their turn.

The pro went to the head of the bed. He told me to take the man by the feet. Which I did. I expected him to lift the man by grasping him below the armpits. No. He grabbed him by the head! I was only 20, just a college kid. I was totally shocked.

We carted him to the morgue. I had never been in a morgue. We left him on the gurney for the morning shift. There were other bodies. They would all be buried in the potter’s field right next door, in plain view out the window. I didn’t sleep well that night.

I got to see a few of the RNs. All those I saw were dedicated, conscientious. Like Gil’s aunt. She worked in a different department and we got to see her only on our off time. The nurses that I saw did their best. There were only four staff doctors in the whole hospital—all immigrants. It seemed they would examine a new patient and make a diagnosis. Then prescribe the appropriate care and medicine and that was that. Well, that was my impression. Oh, some of the patients had been there for years. Chronic diseases can take a long time to kill somebody.

Vividly I remember one patient. Ernie. Slight. About 45 years old, so quite young to be there. . I’m not sure what his diagnosis was. We were given little info. It was plain he was in agony. He was bedridden. He moaned and groaned. He had a huge bedsore at the base of his spine. The size of a grapefruit. An awful raw, red thing gnawing into his flesh. The nurse had put an inflated rubber donut under him. That was the best she could offer.

He would holler. “Help me! Help me! Please!” The whole ward would hear. All I could do was go and roll him to his side a bit. And 30 minutes later, go roll him to his other side. Poor guy. That went on and on. No let-up. Despite the nurses’ best efforts the bedsore was only getting worse. This would not kill him unless it got infected, which was possible.

One thing was obvious. He would have pulled the plug that very day if he had a way to do it. Enough is enough. I knew that. The nurses knew it. There was little more that could be done for him. Nature had to take its course.

But must we wait for nature to take its course? Is that true? Of course, I thought about it. And thought about it. Suppose I had been Ernie? Would I have wanted to soldier on through that excruciating and never-ending pain? When the outlook was so bad. Hell, no!

September approached and Gil and I left to go back to school. I never found out what happened to poor Ernie. But I thought about him. A lot. I dropped out of pre-med. I had gotten an absolutely skewed view of medicine at the hospital. Yes, badly skewed. So did Gil, of course. That was not mainline medical care. No way. Maybe I should have persisted.

But I’ve never regretted my decision. It saddened my mother for sure. But she bounced back. Gil became a dentist. He was an usher at my wedding.

(That September back at Assumption, I got elected editor of our small college newspaper…and I found that exciting. So that’s what got me into doing what I’m still doing.)

And now, Santhara! That ancient Jain tradition for centuries! Only a small number of Jains opt for it. Death is scary for them, too. But it remains a valid and honorable possibility for any Jain. If it makes sense for them, why would it not make sense for others? Maybe you and me some day.

It’s impossible to talk about this and not bring up Dr. Jack Kevorkian. I’m sure you remember him—he was in the headlines for months and months. The doctor who became convinced that some people do have reason to want to die. And he helped them, but only after meeting them and making sure they were legitimate.

He did not kill them. He devised a simple machine that did the job. They had to pull a cord to get it going. When they were hooked up, he would tell them again they could still change their mind. No problem. Well, more than 130 told him to go ahead.

One of our big newsweeklies labeled him Dr. Death. Well, Lots of people all over got to think of him as Dr. Mercy. The more I read about him and thought back on things I had seen for myself, the more I, too, got to see him as Dr. Mercy.

He wanted to change the law. Make what he was doing legal. Make people understand. He felt he had to stage something dramatic. With the consent of a patient, he skipped the machine and injected the medicine into her—I believe it was a woman. And he filmed all this, then rushed the film over to Sixty Minutes and they broadcast it to their millions of viewers. Sensational! That’s the only word to use. Some dammed him. Others thought, Good job!

Well, he was hauled into court again. And this time he was convicted and drew a long prison sentence. He wasn’t surprised. It’s this  publicity that he wanted. Massive publicity. All across the country. Around the world. I believe Dr. Kevorkian went off to serve his time behind bars mighty pleased with himself.

What we are seeing today is the result of what he preached and practiced. And it’s snowballing. Five states have now authorized physician-assisted death.

Santhara is not physician-assisted, of course. But it is “assisted” by the Jains’ long endorsement and support of it. Not many Jains opt for Santhara, but they like the idea it’s available if things get tough. The first state, of course, to approve was Oregon. That happened several years ago. And it seems to be effective. Nobody up there is rushing to go through that, but lots of Oregonians see it the way the Jains do.

And now the latest is California whose huge population—so much bigger than Oregon’s or tiny Vermont’s, which has also passed it—makes the passage of that dramatic new law all the more significant, There had been grave doubts that Gov. Brown—a Catholic and Jesuit-educated–would sign the momentous bill. But he did. He understood.

Certainly other states will follow. Increasingly Americans—like the Jains with their Santhara — are believing that if an awful death looms, their final exit could be easier. And ethical and legal.

What do you think?

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