Religion, Medicine, Bioethics, and the Law in End-of-life Care: South Asian Religious Adherent Perspectives

This study investigates end-of-life care issues in contemporary India from the perspectives of Indian and Tibetan religious adherents, through the lenses of religious studies, bioethics and the law. The need comes from a paucity in bioethics studies related to the ancient Indic religious traditions of Buddhism, Hinduism and Jainism, and from some studies ignoring the non-theistic Indic traditions altogether. Additionally, direct requests came from a Jain community organization for bioethical approaches to an end-of-life ritual fasting and immobilization practice (sallekhanā) as it continues to be legally contested. Medical approaches to decision-making can assist with the dual purposes of protecting vulnerable Jains from coercion and also in satisfying detractors. A major research question was whether religious views impact end-of-life decision- making of patients, families and health care professionals. Although specifically answered in the final chapter, medical decision-making pervades the conversations and analysis throughout, and it is proposed that decision-making moments that involve patients and/or families along with health care providers create micro-level transient neocultures, stemming from Ortiz’s transculturation theory. Three core chapters address: attempts to block disclosure of bad news in sharing of sensitive medical information; ritual fasting and immobilization at the end of life; and exposure to and attitudes towards end-of-life care models including pain management, hospice palliative care and assistance in dying. Primarily ethnographic, the study also uses textual, legal and media analyses.  Field work lasted for six months over 2014-2015 and research took place at four field- sites in India: Delhi, Dharamsala and Jaipur in North India, and Cochin in South India. In-person interviews were conducted with fifty informants belonging to various religious traditions, mainly from the major ancient Indic religions, one medieval Indian religion and the monotheistic Semitic religions for added perspectives. Among the participants were biomedical and traditional healthcare providers, all physicians save one medical student and two nurses. This study is an advocacy anthropology project with hopes that it proves helpful in India and other jurisdictions where South Asian religious adherents receive end-of-life care so that culturally safe care can be better provided. As such, the study ends with a number of practical findings, recommendations and suggestions.Ph.D