Purpose
To contrast with an Australian study, this study aimed to understand Indian cancer patients’ hopes and beliefs about the end-of-life, particularly focusing on how this informed their preferences regarding end-of-life treatment. In India, individuals’ lives are mainly guided by culturally driven practices of doing right by one’s family and believing death is predetermined.
Methods
Indian patients (25) diagnosed with advanced incurable cancer and aware of their prognosis participated in semi-structured interviews exploring their hopes as they approached the end-of-life. The interview also sought to understand patients’ views and beliefs about DNR orders and euthanasia. The interviews were transcribed and analysed using Interpretative Phenomenological Analysis.
Results
Two major themes were identified: (i) a desire for living or dying comprising sub-themes of perceptions of current responsibilities, and, having a fighting spirit versus feelings of despair, and (ii) God was the ultimate decision-maker of life and death. Further, patients understood that a do-not-resuscitate order meant euthanasia and responded accordingly. Some patients reported hoping for death due to the pain and resultant suffering. However, patients did not talk about euthanasia openly, instead choosing to describe it within a larger framework of life and death.
Conclusions
Indian patients reaching the end-of-life valued their family responsibilities which determined their desire to live or die. However, all patients believed that God decided on their life and death. It is important to consider cultural perspectives on DNR or euthanasia, and to address patients’ pain management needs towards the end-of-life.