Christian Ethical Response to End-of-Life Care (An Indigenous Communitarian Health Care Approach)

About The Book

This book is a welcome contribution to the research area of the ethics of health care in general and indigenous health care practices in particular. It certainly raises critical questions on the prevailing health care conditions as regards End of Life issues in India and part of Northeast, especially in the Lotha Naga community. It exposes the poor health care infrastructure in the country, on the one hand, and formulates an indigenous response to the failure of health care practices, on the other. The book engages in conversations with dominant Christian Ethics and provides critique from an indigenous perspective, as it systematically unearths moral gaps in dominant Christian/Secular health care ethics. The book further explicates appropriation of Lotha Naga Indigenous theology and ethics from a senior people's perspective.

About the Author

Dr O. James Kithan hails from Wokha Village, Nagaland. He completed his B.D from Clark Theological College, Aolijen, Mokokchung in 2008; Master of Theology (Christian Ethics) in 2013, and Doctorate of Theology from United Theological College, Bangalore in 2021.

From the last 10 years, he has been involved in Church Ministry; 3 years in Youth Ministry and 7 years in pastoral ministry at Wokha Village Baptist Church. Presently he is serving as the Vice Principal at Witter Theological College, Vankhosung, Nagaland, India. He is married to Jandeno and they are blessed with two children, Ronachan and Kumroni.

Preface

The rationality of this book is a welcome contribution to the research area of the ethics of health care in general and indigenous health care practices in particular. It certainly raises critical questions on the prevailing health care conditions as regards End of Life issues in India and part of Northeast, especially in the Lotha Naga community. It exposes the poor health care infrastructure in the country, on the one hand, and formulates an indigenous response to the failure of health care practices, on the other.

It employs postmodernism as a methodological framework by taking Jean-Francois Lyotard's critique of meta-narratives. Lyotard sees meta- narratives as an ideology of the dominant regime that has a monopoly on knowledge and Lyotard opposes it and proposes for a new world of knowledge based on 'mini narratives' or small narratives. Participant-observation method was used to deal with the EOLC among the senior people in Lotha Naga. Ethnographic interview method was used to direct one-on-one interview to generate ideas and to understand the people needing care and their family better. The present research mainly focuses on the rural areas of Wokha District, Nagaland. This enables the researcher to know how the person needing care and their families experience their daily struggles and pain and the most crucial dilemmas they face in terms of health care. The researcher employed indigenous communitarian elements especially the Lotha Naga concept of in developing indigenous communitarian ethics in order to address the EOLC among senior people in Lotha Naga.

In the first chapter, it carries out a critique of health care system in India in the context of EOLC with special reference to senior people in Lotha Naga community. It exposes the Western health care system that was introduced in India for its political and economic gain. Moreover, they also developed an indifferent attitude towards indigenous medicine and healthcare practices by branding them as non-scientific, non-modern system of medicine.

Foreword

I am truly pleased to write the foreword for James Kithan's book based on his doctoral thesis which I had the opportunity to supervise. This is certainly a unique contribution to the research area of the ethics of health care in general and indigenous health care practices in particular. That said, the book assesses and certainly raises crucial questions on the prevailing health care conditions as regards the End-of-Life issues in India and parts of North East India, especially in the Lotha Naga Community. The chapters are built on each other to argue and expose the poor health infrastructure in the country, on the one hand, and formulate an indigenous response to the failure of health care practices, on the other.

The research chooses Jean-Francois Lyotard's critique of meta-narratives as a perspectival entry with grounding in Public theology and Health care ethics. The book particularly employs participant observation method to interview the Lotha Naga senior people in Wokha district, especially in the rural areas articulating the closeted experiences of the senior people. The evaluation and analysis follows these findings. That said, the Lotha Naga view of health care is an important contribution to the discourse of health care in India. The plea for the recovery of indigenous ethos is commendable as there is originality in tracing the roots of Lotha Naga communitarian ethos.

The book deserves acclaim due to the attempted conversations between dominant Christian Ethics and critique from an indigenous perspective as it systematically unearths "moral gaps" in dominant Christian/Secular heath care ethics. The book further explicates appropriation of Lotha Naga indigenous theology and ethics from a senior people's perspective.

Introduction

End-of-life care is a crucial area in healthcare ethics where the persons needing care, their families, and healthcare givers encounter challenges regarding decisions to be made that are undergirded by the dignity and respect of life. Consequently, the erosion of end-of-life care, especially faced by senior people, continues to be the most challenging issue in contemporary Lotha Naga community. Therefore, it is pertinent to identify the moral gaps that are inherent in the end-of-life care and seek to posit an indigenous communitarian healthcare ethics from the Lotha Naga senior people perspective.

1. Rationale of the Ethics of End-of-Life Care

The end-of-life care! (hereafter EOLC) is one among the challenging situations encountered by doctors, persons needing care and their families in the healthcare system. In addition, inadequate human and economic resources lead to the terminally-ill patients to develop diverse layers of problems. India being a country where defensive healthcare practice is encouraged, and the concept of death is surrounded by a culture of silence, there are possibilities that medical procedures could still be prescribed however futile the case may seem. The people in need of EOLC are individuals who have gone through tumultuous phases in life. They are individuals with various illnesses that do not give any chance of survival; their bodies have undergone a series of treatments. These are usually individuals caught in a web of chaotic thought patterns, disappointments, loss of motivations to live, worried about the family, the future and security, feelings of alienation, and being unwanted. During the end-of-life situation, life support interventions will not mitigate their suffering. but rather will add to the agony and burden of a prolonged dying process. Death may become artificial, away from the family and continuously surrounded by the paraphernalia of modern critical care. Moreover, the inappropriate and aggressive medical interventions at ELOC drain the resources of the person needing care and their family. Prolonged and futile life support will, however, undoubtedly impose enormous economic strains on patients and families.' The senior people, therefore, form a significant proportion of candidates for end- of-life care due to multiplicity of coexisting chronic diseases.

There is usually a moral-gap in ethical/ideological framework and practical action. There is a conflict between opposing moral theories, each of which claims to provide the best account of the moral life and each of which claims to exclude all the others. There is also a biased secular version of healthcare ethics. It is a secular version of healthcare ethics that overlooks the religious virtues of compassion, care, faith and humility. The healthcare system is dominated by the private health care system. Allan Samuel Palanna points out that "health care in India is entirely comprised of out-of-pocket expenses borne by the consumer, and supplemented by donations from charitable organizations, insurance schemes and non-governmental organizations." Moreover, private and corporate hospital chains have mushroomed in larger towns and cities. Hence, the public health care system that serves the common people has lost its taste and on the varge of collapsing. EOLC for the senior people in public healthcare system is very poor in terms of infrastructures, services, policies, funds, facilities and resources.

**Contents and Sample Pages**