Bridging Cultural and Ethical Gaps: The Role of Interpreters in Facilitating Hindu End-of-Life Decision-Making
Aigerim Aliakparova, MSc, Duquesne University, Pittsburgh, PA
End-of-life (EOL) care is one of the crucial phases in healthcare delivery. EOL decision-making refers to the process of making informed medical and personal choices for individuals approaching the final stages of life. These decisions are often very complex and involve in-depth discussions about the desired types of medical interventions, especially for patients with non-English language preference. In such sensitive times, it is essential to provide culturally, linguistically and spiritually respectful care that acknowledges the patient’s unique perspectives on life, death, and the legacy they wish to leave, and the role of the medical interpreter is invaluable. Medical interpreters not only translate words but also to convey the meaning, tone, and context of what is being said, helping to clarify misunderstandings that may arise from cultural differences, ensuring that both the patient and the provider understand each other clearly. This paper will explore the features of EOL decision-making for Hindu patients and the role of the medical interpreter within the intensive care unit (ICU) in facilitating those decisions.
As the United States becomes increasingly multicultural, healthcare providers are tasked with adapting to diverse beliefs about end-of-life EOL. Hinduism is known to be the fourth-largest religion in the U.S., presents distinct views on life and death rooted in karmic principles and dharma. For many Hindus, the concepts of “good” and “bad” death are deeply intertwined with these moral and spiritual beliefs. In Hindu culture, death is believed to be not an end but a transition, which brings a unique perspective to EOL decisions, especially balancing dharma, which is understood as one’s righteous duty to karma, the law of moral cause, which is virtuously moderated by the principle of non-harm (ahimsa) and driven by the environmental background samskara. Collectively, these principles believed to affect EOL decision-making, facilitating a peaceful journey to the afterlife according to spiritual beliefs.
Opposite to Western bioethics, where patients' autonomy is usually emphasizes as central, Hindu ethical perspectives prioritize collective responsibilities and moral obligations. When it comes to EOL decisions, this difference becomes especially significant, as the surrogate’s role transcends mere representation of the patient’s wishes to include considerations of spiritual and societal implications.
The concept of a surrogate in Hinduism is less addressed in the literature and appears very complex. In the contacts of Hindu bioethics, surrogates are not just decision-makers but also custodians of the patient’s karmic path and bearers of the responsibility to make choices that align with the patient’s dharma. Unlike in Western frameworks, where a surrogate primarily advocates the patient’s personal preferences, the surrogate in Hindu culture is assumed to have a more extensive, profound ethical responsibility. According to Hindu beliefs, surrogate duty extends to weighing the patient’s spiritual journey, aiming to balance respecting the patient’s wishes with the family’s collective responsibility. This responsibility places the surrogate in a unique ethical position. While they are trying to make choices that honor the patient’s values, they are also seen as potentially influencing the patient’s karmic path, and the surrogate, in making such decisions, becomes partly accountable for these outcomes. Moreover, desire for care is unique in Hindu bioethics, especially within a family, shaping the surrogate’s role as a moral and familial responsibility figure, and seen as not a separate or isolated decision-maker but as part of a larger family and community.
The absence of a single, unified doctrine in Hinduism adds further complexity to surrogate decision-making. While certain general bioethical principles like karma and dharma are widely recognized, the practical variation of the Hindu religion differs across families, known to be driven by samskara, which means each family’s approach to EOL decisions can differ significantly. Therefore, no unified assumptions can be made about Hindu patients’ preferences or decisions; healthcare providers must engage in culturally responsive, individualized discussions to allow families to clarify their unique perspectives and values.
Given the complexity of surrogacy within Hindu culture, medical interpreters become indispensable in helping providers understand the surrogate’s role and the cultural and spiritual values at play. By helping providers navigate insights into specific ethical considerations and communal expectations that are driving Hindu family’s decision-making, interpreters help healthcare teams to properly understand surrogacy and engage in nuanced discussions that respect patients and family values. This paper builds on existing research concerning language access in healthcare and the role the interpretation services in ICU. Previous publications have explored the negative impact of communication failures in healthcare, but this work focuses explicitly on the role of the medical interpreters in defining surrogacy for Hindu patients and facilitating EOL decision-making.
As the United States becomes increasingly multicultural, healthcare providers are tasked with adapting to diverse beliefs about end-of-life EOL. Hinduism is known to be the fourth-largest religion in the U.S., presents distinct views on life and death rooted in karmic principles and dharma. For many Hindus, the concepts of “good” and “bad” death are deeply intertwined with these moral and spiritual beliefs. In Hindu culture, death is believed to be not an end but a transition, which brings a unique perspective to EOL decisions, especially balancing dharma, which is understood as one’s righteous duty to karma, the law of moral cause, which is virtuously moderated by the principle of non-harm (ahimsa) and driven by the environmental background samskara. Collectively, these principles believed to affect EOL decision-making, facilitating a peaceful journey to the afterlife according to spiritual beliefs.
Opposite to Western bioethics, where patients' autonomy is usually emphasizes as central, Hindu ethical perspectives prioritize collective responsibilities and moral obligations. When it comes to EOL decisions, this difference becomes especially significant, as the surrogate’s role transcends mere representation of the patient’s wishes to include considerations of spiritual and societal implications.
The concept of a surrogate in Hinduism is less addressed in the literature and appears very complex. In the contacts of Hindu bioethics, surrogates are not just decision-makers but also custodians of the patient’s karmic path and bearers of the responsibility to make choices that align with the patient’s dharma. Unlike in Western frameworks, where a surrogate primarily advocates the patient’s personal preferences, the surrogate in Hindu culture is assumed to have a more extensive, profound ethical responsibility. According to Hindu beliefs, surrogate duty extends to weighing the patient’s spiritual journey, aiming to balance respecting the patient’s wishes with the family’s collective responsibility. This responsibility places the surrogate in a unique ethical position. While they are trying to make choices that honor the patient’s values, they are also seen as potentially influencing the patient’s karmic path, and the surrogate, in making such decisions, becomes partly accountable for these outcomes. Moreover, desire for care is unique in Hindu bioethics, especially within a family, shaping the surrogate’s role as a moral and familial responsibility figure, and seen as not a separate or isolated decision-maker but as part of a larger family and community.
The absence of a single, unified doctrine in Hinduism adds further complexity to surrogate decision-making. While certain general bioethical principles like karma and dharma are widely recognized, the practical variation of the Hindu religion differs across families, known to be driven by samskara, which means each family’s approach to EOL decisions can differ significantly. Therefore, no unified assumptions can be made about Hindu patients’ preferences or decisions; healthcare providers must engage in culturally responsive, individualized discussions to allow families to clarify their unique perspectives and values.
Given the complexity of surrogacy within Hindu culture, medical interpreters become indispensable in helping providers understand the surrogate’s role and the cultural and spiritual values at play. By helping providers navigate insights into specific ethical considerations and communal expectations that are driving Hindu family’s decision-making, interpreters help healthcare teams to properly understand surrogacy and engage in nuanced discussions that respect patients and family values. This paper builds on existing research concerning language access in healthcare and the role the interpretation services in ICU. Previous publications have explored the negative impact of communication failures in healthcare, but this work focuses explicitly on the role of the medical interpreters in defining surrogacy for Hindu patients and facilitating EOL decision-making.