For over six decades now India has seen substantial improvements in its health care delivery systems, and esp. in the last two decades the systems have been moving at a galloping pace. India has now become a desired spot for medical tourism with its state of the art hospitals in major metropolitan areas. But all this has not closed the gap in access to care due to geography and abject poverty, for multitudes of Indians in both rural and urban areas. The problem of access is the foremost ethical challenge for populations vulnerable because of age (viz. children), women, tribal and others of socially disadvantaged lower rungs of the Hindu social order, and of course those who are simply poor.
No discussion of ethics of whatever kind in Hindu society and culture can be meaningful without an appreciation of the fact that this tradition is non-canonical, has no central authority of a church, a priestly order, a book or a Messianic figure, permitting its adherents at once an unfettered freedom to worship and variable codes of conduct appropriate for particular persons, places, and times. Patterns of kinship, rules about exchange, esp. cooked food and marriage were the threads that bound a group together as well as drawing a permeable boundary around it. Various subgroups including castes and sub castes, with their internal governance in the past have provided generally enforceable rules of social and personal conduct, but this structure is rapidly losing its center because of unprecedented urban (even diasporic) migration and the anonymity of mega cities. Protection to vulnerable groups provided within the umbrella of the intra-caste networks is thus disappearing in many places. In reaction to these phenomena, a more virulent assertion of caste rules in semi urban and affluent rural areas has arisen, eroding newly acquired autonomy by the young, esp. in sexual conduct and mate selection.
Ideas of personal autonomy are a modern western import. The Hindu person , as anthropologist McKim Marriott has argued, is a “dividual,” not an individual, meaning that the person is not an indivisible unit of society. The Hindu self is not bounded by its skin, and both the phenomenal or ego self and the body are permeable, in constant flux and in a series of exchanges with their human and material environments, Dependence of those lower through age, gender, caste status, and other qualities, upon the higher, with the return obligation of patronage and protection, is defined by traditional arrangements. Only a person’s inner self, the soul- like atman was indivisible and so untouched and unsullied by phenomenal transactions. In this world view neither “a man’s home or his body” were a” castle” and in “ personal” matters affecting the self and the body the family’s chief males made decisions for dependant members of the family. For example medications were given without consent or the under false pretext, keeping the ill person in the dark about the nature of illness or the prognosis . Modern secular laws are clearly in conflict with these values and are ignored as a rule. These prevailing attitudes do not necessarily accord with a dependant person’s wishes which are often suppressed, voluntarily or occasionally otherwise.