Percubaan untuk menjelajahi dan memahami konsep kerohanian serta implikasinya dalam penjagaan di penghujung hayat semakin meningkat di seluruh dunia. Komuniti yang membantu menenangkan masyarakat di India dalam tempoh 30 tahun sejarahnya telah menunjukkan komitmen yang tinggi dengan memperdalam dasar pengetahuan mengenai aspek spiritual dalam penjagaan paliatif melalui penyelidikan yang berterusan.
The first systematic review of studies related to spirituality at the end of life in India was published in 2015, which analysed 39 empirical studies and 18 reviews, opinion and discussion papers (Gielen, Bhatnagar, & Chaturvedi, 2016). While promoting an understanding of spirituality based on patient and staff perspectives, these studies have highlighted the need for unpacking the historical and cultural meanings of concepts that shaped the understanding of spirituality in the Indian context. Studies have demonstrated that Indian philosophical and religious concepts such as Karma, dharma, ātman and the notion of rebirth, for example, have a considerable influence on Indian perceptions of spirituality at the end of life (Chattopadhyay & Simon, 2008; Desai, 1988). Establishing an overview of the philosophical concepts is crucial for understanding their influence on perceptions of spirituality.
Despite the historical link between spirituality and theology/philosophy, the recent approaches to studying spirituality lack attention to philosophical and theological underpinnings of spirituality. Most studies on spirituality at the end of life seek empirical evidence based on interviews and the historical and cultural components of spirituality are often left unexplored (Inbadas, 2016). Far less theoretical research is found on the subject and consequently, the philosophical basis of spirituality attract little attention (Cobb, Dowrick, & Lloyd-Williams, 2012). Empirical evidence makes significant contribution in identifying ‘what’ constitutes spirituality for a given population. However, without theoretical exploration of concepts and philosophical thoughts, answering the questions of ‘why’ and ‘how’ various values and principles gain significance to constitute the content of spirituality in particular contexts remains challenging to answer.
Philosophy constitutes one of the key conceptual areas necessary for understanding spirituality (Cobb, 2001). There are a few examples of engagement with philosophical concepts drawing from modern western philosophers to understand and explain spirituality and its relationship and implications for health and health care (Eseadi et al., 2015; Goddard, 1995; Henery, 2003; Patterson, 1998; Pesut & Sawatzky, 2006). In the context of end of life care in India, several avenues for potential engagements with the Indian philosophical fabric can be identified. Vedic texts of ancient India consider the care of the dying as one of life’s major responsibilities (Davidson, 1988). Movements within Hinduism (e.g. bhaktimarga) have specific teachings about how to approach end of life along with teachings on monastic life, celibacy, etc., which are also found in classical literature (Firth, 2005). While the Vedic traditions represent the philosophical streams of the north India, resources from the philosophical traditions of Siddhars offer the Dravidian perspective from the southern part of the country (Ganapathy, 1993).
Empirical studies from the Indian context indicate the influence of Indian philosophical thoughts on current notions of spirituality at the end of life. Indian philosophical and religious concepts often appear in interviews with palliative care patients and palliative care professionals (Elsner, Schmidt, Rajagopal, Radbruch, & Pestinger, 2012; Manghrani & Kapadia, 2006; Simha, Noble, & Chaturvedi, 2013). Considering the profound relationship between Indian spirituality and Indian philosophy, exploring the philosophical foundations of aspects of Indian thought and worldview that impact the understanding of spirituality at the end of life becomes crucial. This paper, therefore, aims to present a review of selected philosophical and cultural literature from the Indian context to establish the philosophical foundations of spirituality specific to the end of life.
It is necessary to highlight some features of Indian philosophy and its relationship to spirituality. India has a rich philosophical heritage over several thousands of years. These ancient philosophical traditions had many schools of thoughts and had substantial body of intellectual argumentation about reality, the human person and their inter-relatedness. Jitendra Nath Mohanty, a renowned Indian philosopher, defines philosophy as reflections on experiences of human persons involved in time and history – about the self, others and the world (Mohanty, 1993). It is important to recognise that there is no ‘Indian philosophy’ that represents the whole of the Indian subcontinent. There are specific regional traditions that represent the historical and philosophical worldview of parts of the country and over several periods of time. For example, Vedic philosophy captures the Aryan cultural tenets predominant in the northern parts of the country and Shaiva Siddhānta is a tradition that has a specific Tamil lineage referring to the life and culture in South India, popularly known as the Dravidian culture (Ganapathy, 1993; Kesavan, 1997). Some of these philosophical traditions find their expressions in the forms of classical poetry. In Tamil literature, for example, Thirukkural and Sanga ilakkiyankal are among the most notable examples for this.
Indian scholars have shown that philosophy, religion and medicine belonged together in ancient India and that they together captured Indian worldview (Ganeri, 2007; Kutumbiah, 1999). Rajendra Prasad’s definition of Indian philosophy illustrates the relationship between spirituality and philosophy in India: Indian philosophy ‘is a reflective, reasoned account given by classical thinkers, of their spiritual intuitions of what the ultimate, most basic reality is’ (Prasad, 2008, p. 27). Another scholar, Dasgupta (1922) in his historical overview of all the major Indian philosophical traditions, observes that despite variations between the different traditions, three main doctrines remain commonly significant for all of them: the doctrines of karma – the principle of causality, mukti – release from the cycle of life in this world, and soul, ātma – the ‘inner-self’ of the human person. These common doctrines of Indian philosophical traditions also testify to the relationship between philosophy and spirituality in the Indian context.
Recognising that this affiliation is fundamental to understanding the philosophical foundations of Indian spirituality at the end of life, I undertook a review of philosophical and classical Indian literature that shed light on relevant themes. Given the complexity and expanse of Indian philosophy spread over thousands of years of oral, visual and written traditions this paper does not claim to offer a comprehensive review of all philosophical traditions. Much of these reviews involved engagements with strands of Vedantic and Dravidian philosophical traditions. The key points that emerge may have resonance with others philosophical traditions, both of Indian origin and of wider contexts.
Spirituality as an ‘essence of the human person’ and its close association with the ‘meaning and purpose of life’ feature as the most prominent themes in defining spirituality in end of life care research (Cobb, 2001; Fegg et al., 2010; Hermsen & ten Have, 2004; Kellehear, 2000; Narayanasamy, 2006; Swinton, 2010; Swinton & Narayanasamy, 2002). In addition, the context of end of life can be considerably influenced by philosophical and cultural meanings of death. I therefore engage in an Indian philosophical exploration of the three concepts that seem to be the key in shaping the understanding of spirituality at the end of life, namely: the concept of the human person, the purpose of human life and the understanding of death.
