As a second-generation immigrant from India, I have always been curious about the end-of-life care situation there. From what I know, culturally, India strongly emphasizes family values and traditions, where children grow up and take special care of their parents. In this regard, I have always been interested in learning more about how this cultural norm is reflected in the healthcare system and the end-of-life care practices in India.

India is a developing country; its age population is increasing, and there is a prevalence of cancer; every hour, more than 60 patients die in India from cancer. The need for palliative care is necessary. Palliative care refers to medical caregiving aimed to optimize the quality of life of those suffering from painful or terminal illnesses. 500 centers are providing palliative care in India, mainly in urban areas. This poses a problem because many Indians are very poor and do not live in cities. If someone becomes terminally ill, they would have no one to go to, and the impact on their families is great. The concept of palliative care is still relatively new in India and is still at an early age of development. Less than 3% of India’s cancer patients have access to adequate pain relief. Making palliative care more developed and effective in India will be difficult due to various issues. Generally, there appears to be a lack of interest in caring for those with terminal illnesses. This was, in fact, surprising, considering how family-oriented the culture is. Additionally, India is very diverse, so implementing palliative care will mean each state has to develop its own policy according to its conditions, such as its social/cultural background. 

Religion also has an impact on how end-of-life is handled. India is diverse in religions, including Hinduism, Buddhism, Christianity, and Islam. Hinduism is the main religion of India and views death as a transition to another life by reincarnation. There is a strong belief in a ‘good death’ versus a ‘bad death.’ A good death can be achieved by good karma or doing good deeds throughout life; however, one will have a bad death and rebirth if they have bad karma. Those who are suffering from illness detach themselves from material and emotional concerns while preparing for death through prayer and meditation. Hinduism puts emphasis on accepting death as is; for example, a dying person would refuse medication as they view the pain they feel as a cleansing of their previous sins. This is also why suicide is considered selfish and morally wrong and will surely lead to a bad death.

Contrastingly, Buddhism believes in the afterlife, where the goal is to reach nirvana, which is the freedom of the cycle of suffering and rebirth. They also don’t like using medications, as it is believed that they may alter one’s state of mind and affect one’s life transition and rebirth. 

Christians view death as a consequence of a sin, where the soul and body temporarily separate. Christians may view the illness as punishment and thus may have guilt associated with the illness. Death anxiety is also very present as the Christian belief that a soul either goes to heaven or hell is prevalent. 

In Islam, there is the belief in accepting suffering as a submission to god. However, unlike previous religions mentioned, it affirms the use of narcotic painkillers for the management of severe pain while disapproving methods to hasten death (or disapprove of euthanasia, which will be discussed shortly).

Overall, the most common theme in these religions mentioned is that death should not be tampered with, including ending life earlier or delaying death. This may be another reason people choose not to receive palliative care in India. 

Discussions of end-of-life care cannot be complete without mentioning Euthanasia. This is defined as the administration of a lethal agent by another person to a patient to relieve the patient of suffering. Furthermore, there is active and passive euthanasia. In active Euthanasia, a physician will deliberately act in a way to end a patient’s life, while passive euthanasia happens due to withholding or withdrawing the treatment that maintains life. Similarly, physician-assisted suicide (PAS) involves a physician providing medications or advice to enable the patient to end their own life. In either case, the intent is to relieve suffering. 

There is a lot of debate around the morality of euthanasia; some say that it is immoral, while others advocate for it to be legalized. In India, in almost all cases, euthanasia is considered unconstitutional. However, for years, there have been legal proponents advocating for euthanasia, leading India to allow passive euthanasia for exceptional cases. Other than that, the patient cannot ask to be killed but rather can refuse treatment.  Proponents of the legalization of PAS argue that it is an act of humanity toward the terminally ill patient; additionally, they argue that the Supreme Court draws a distinction between active and passive euthanasia when they believe there is no difference. In either case, the physician takes some voluntary action to hasten the patient’s death, and therefore, if passive euthanasia is allowed, so should active euthanasia. The underlying belief is that knowing and controlling one’s own death is a form of “psychological insurance”. 

In conclusion, end-of-life care practices in India are still developing, and there are various challenges in implementing palliative care. The cultural norms and diverse religious beliefs in India have a significant impact on how end-of-life is handled. While the concept of palliative care is still relatively new in India, it is crucial that the healthcare system improves to meet the needs of the aging population and those suffering from terminal illnesses.