Honouring Traditions: Integrating Cultural Wisdom into Palliative Care – Saif Mohammed

My ancestral home, nestled in a village in Kerala, was a place where caregiving was a natural part of life. When my grandfather suffered a stroke at the age of 68, his care became a shared responsibility. My uncles and aunts worked together, creating a structured caregiving system while also enlisting the support of a palliative care team.

Over time, the home care team reduced their visits, having successfully trained my family members to provide the necessary care.

Reflecting on this experience, I realize that caregiving is deeply embedded in tradition and culture, a natural extension of communal life.

Caregiving is as old as humanity itself. One of the earliest known cases of palliative care dates back 45,000 years to Shanidar 1, a Neanderthal male found in present-day Iraq. His skeletal remains indicated severe injuries, yet he had survived for decades, suggesting that his community had cared for him. This example highlights that palliative care is a deeply human and historical practice, far predating modern medicine.

Cultures around the world continue to recognize the importance of caregiving, often embedding it in traditions and religious beliefs.

In East Asia, filial piety—a Confucian principle—places a strong emphasis on respect and care for elders. In China, the Elderly Rights Law mandates that adult children visit and support aging parents. Bhutan’s Buddhist values emphasize peace and continuity in illness and death, with bereavement leave granted for families to complete religious rites. Similarly, in India, post-death rituals provide collective bereavement support, reinforcing the importance of a culturally inclusive approach to palliative care.

While cultural traditions often align with palliative care principles, challenges can arise when beliefs conflict with medical recommendations.

Consider the case of Mr. X, a patient with terminal cancer who was admitted to the Institute of Palliative Medicine. His doctor prescribed morphine for pain relief, yet his family was strongly opposed to administering it. Their religious beliefs held that suffering in this life would lessen suffering in future incarnations. This created an ethical dilemma for the palliative care team, who had to balance medical best practices with cultural sensitivity.

Similarly, tension exists between modern medicine and traditional healing practices such as Ayurveda and homeopathy. In some communities, patients might prefer traditional remedies over conventional palliative treatments.

In some societies, the emphasis on independence can make caregiving more complex, as patients may refuse assistance to maintain self-sufficiency.

These cases highlight the need for culturally competent palliative care—where medical professionals respect cultural values while ensuring that patients receive the best possible care.

Palliative care workers must be equipped to understand and respect the cultural traditions of the communities they serve. This requires training in cultural competence, which involves:

1. Exploring Cultural Beliefs and Practices – Engaging with patients and families to understand their customs, spiritual beliefs, and preferences.
2. Respecting Diversity Without Imposing Norms – Acknowledging differences without dictating terms or invalidating beliefs.
3. Being Mindful of One’s Own Cultural Biases – Recognizing how personal beliefs may shape perceptions of death, dying, and bereavement.
4. Adapting Care Strategies – Integrating cultural traditions into palliative care practices, such as facilitating religious rituals or traditional healing practices when appropriate.

 

Palliative care is not an external concept imposed on communities—it is a continuation of long-standing caregiving traditions.

 

By understanding and incorporating cultural beliefs into palliative care, we can provide person-centered care that honours the values and traditions of patients and their families. The challenge lies in ensuring that these traditions support well-being while navigating potential conflicts with palliative care principles.

As Arthur Kleinman states,

“The need for care is universal, yet there is no universal template for providing it.”

Culturally competent palliative care is about bridging the gap between tradition and modernity, fostering a compassionate, inclusive, and respectful approach to end-of-life care.

References

• Kleinman, A., Eisenberg, L., & Good, B. (1978). Culture, Illness, and Care: Clinical Lessons from Anthropologic and Cross-Cultural Research.
• Clark, K., & Phillips, J. (2023). End-of-Life Care: The Importance of Culture and Ethnicity.
• Senior, K. (2023). The Aboriginal Definition of Health.
• The Elderly Rights Law, China (2013).

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Author: Saif Mohammed (photo attached)

Academic Consultant, Institute of Palliative Medicine WHO CC

Can be reached at saifsabil@gmail.com

Faculty member, World Health Organisation Collaborating Centre, Institute of Palliative Medicine WHOCC

Former state program manager, Govt Palliative Care Program, Kerala

Former CEO, Mission Better Tomorrow