Religion, Medicine, Bioethics, and the Law in End-of-life Care

---

“Religion, Medicine, Bioethics, and the Law in End-of-life Care”

A talk on doctoral research by Sean Hillman (PhD, Religion/Bioethics/South Asian Studies, U of T 2019), Clinical Ethicist at Lakeridge Health (Centre for Clinical Ethics) and also Buddhist Corrections Chaplain at Bath and Collins Bay Institutions.

Register at https://munkschool.utoronto.ca/ai/event/29261/

This talk is based on a recently defended doctoral study investigating 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 came in part 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. 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 offers a number of practical findings, recommendations and suggestions. The chapter on ritual fasting at the end-of-life is currently being published in a collection on the topic in India, edited by Prof. Chistopher Chapple.

Dr. Sean Hillman is a clinical bioethicist with the Centre for Clinical Ethics (CCE), a consultant organization based at Unity Health Toronto and contracted to seven institutions in Ontario. Over the last several years Sean has been the ethics lead for the five-hospital Lakeridge Health system in Durham region. He also is a Buddhist Corrections Chaplain for two facilities in the Kingston region. Sean was a bedside caregiver in hospital for almost two decades and did a year-long fellowship in Clinical and Organizational Bioethics also at the CCE. A medical anthropologist and textualist, Sean recently completed his doctorate in religion and the collaborative programs of
bioethics and south Asian studies at U of T.

A scholar of various Asian philosophies and languages for almost thirty years, with a major focus on the Indic religious traditions, Sean has spent five years living, studying and researching in India. Sean’s current research projects are on maximizing decisional participation by those who might have mental capacity interferences, and on how to better understand why families may request aggressive medical management for their loved-ones despite a poor prognosis (including religious logic such as vitalism, non-harm and filial piety). Sean is a member of Durham Family Resources community advisory committee for their “recognizing capacity” pilot project which advocates for increased inclusion of those with intellectual, cognitive or communication challenges and for including supported decision making in Ontario healthcare law.