East meets West: Cross-cultural perspective in end-of-life decision making from Indian and German viewpoints

Abstract

Culture creates the context within which individuals experience life and comprehend moral meaning of illness, suffering and death. The ways the patient, family and the physician communicate and make decisions in the end-of-life care are profoundly influenced by culture. What is considered as right or wrong in the healthcare setting may depend on the socio-cultural context. The present article is intended to delve into the cross-cultural perspectives in ethical decision making in the end-of-life scenario. We attempt to address the dynamics of the roles of patient, family and physician therein across two countries from East and West, namely, India and Germany. In India, where illness is more a shared family affair than an individual incident, a physician is likely to respect the family's wishes and may withhold the [Symbol: see text]naked truth' about the diagnosis of a fatal disease to the patient. In Germany, a physician is legally required to inform the patient about the disease. In India, advance directive being virtually non-existent, the family acts as the locus of the decision-making process, taking into account the economic cost of available medical care. In Germany, advance directive is regarded as mandatory and healthcare is covered by insurance. Family and the physician appear to play larger roles in ethical decision making for patients in India than for those in Germany, who place greater emphasis on autonomy of the individual patient. Our study explicates how culture matters in ethical decision-making and why the bioethical discourse is necessary in the concrete realities of the socio-cultural context. To explore the possibility of finding a common ground of morality across different cultures while acknowledging and respecting cultural diversity, thus remains a formidable challenge for the bioethicists.

History, Culture and Traditions: The Silent Spaces in the Study of Spirituality at the End of Life

“…Several scholars have highlighted the historic connectedness between spirituality and healthcare both in the western and eastern traditions [53][54][55]. The root of this relationship is often located in the understanding of illness as a "spiritual event" that "grasps persons by the soul and by the body and disturbs them both" [38].…”

Education in care ethics: a way to increase palliative care awareness in India

“…This kind of legislation would be unthinkable in countries such as India where the family and the treating physician play a much larger role in the medical decision making process than in the West (Raj 2012;Seetharam and Zanotti 2009;Senarath and Gunawardena 2009;Chattopadhyay and Simon 2008;Chaturvedi 2008). Partially, this intervention of others in decision making can be explained by paternalism.…”

“…People tend to get involved in the decisions driven by concern not only for the patient but also for all other people who may be affected by the treatment decision. Family members of patients often withhold medical information from a patient with advanced disease, because they are afraid that knowledge about the diagnosis and prognosis will destroy the patient's hope and in this way accelerate the disease progress or complicate emotional wellbeing (Chattopadhyay and Simon 2008;Raj 2012). But oftentimes, when treatment decisions are made the wellbeing of the family is also at stake.…”

“…Due to a lack of health insurance, most healthcare spending in India is out-of-pocket. Therefore, a terminal illness of a family member can literally ruin a family's finances, particularly when the breadwinner is struck by the disease (Chattopadhyay and Simon 2008). In such a context, involvement of the family in the decision making process is much more obvious.…”

Indian philosophical foundations of spirituality at the end of life

“…While promoting an understanding of spirituality based on patient and staff perspectives, these studies have highlighted the need for unpacking the historical and cultural meanings of concepts that shaped the understanding of spirituality in the Indian context. Studies have demonstrated that Indian philosophical and religious concepts such as Karma , dharma , ātman and the notion of rebirth, for example, have a considerable influence on Indian perceptions of spirituality at the end of life (Chattopadhyay & Simon, 2008; Desai, 1988). Establishing an overview of the philosophical concepts is crucial for understanding their influence on perceptions of spirituality.…”