Amanitvam: a concept from the Bhagavad Gita applicable in medical ethics

The Bhagavad Gita is one of the most ancient, venerated and popular religious texts originating from India. It provides an excellent insight into the tenets of Hinduism. The Bhagavad Gita was originally a part of the Mahabharata, and was essentially a dialogue about ethical dilemmas and moral philosophies between a teacher (Krishna) and a disciple (Arjuna). It is considered one of the foundational and most important books in Hinduism. The text provides a synthesis of spiritualism and dharmic ideas, and this text has found widespread acceptance across India, and in regions where there is a strong presence of an Indian diaspora or individuals who have embraced Hinduism. There are several words and sentences in the Bhagavad Gita that are of pertinence to ethics in general, but I believe that there is one in particular, that has a great degree of fit with medical ethics. I refer to the word amanitvam. This word amanitvam refers to humility, and it refers to a concept that Krishna advised Arjuna to embody. I strongly believe that this particular word is deeply applicable in a medical ethics context, and indeed, may help physicians become more ethical in their own approaches. This word amanitvam has to do with doing away with unwarranted pride simply due to one’s accomplishments be it education or wealth or social status. Physicians have come to occupy a fairly prominent place in most societal hierarchies, and resultantly, the educational qualifications that are necessary to become a physician are both arduous and plaudit worthy. However, a physician feeling proud that he or she is a wealthyeducated individual, could result in situations where such physicians refuse to acknowledge other individuals’ experiences, and disregard them. Consider that there is an entire spectrum of research that suggests that there are gender and racial disparities in pain management treatment. For instance, many physicians dismiss their women patients’ medical concerns, and tell them that they are overreacting. This dismissal of patients concerns can have significant and drastic consequences for patients, including a needless prolonging of suffering, not to mention a general feeling of being gaslit by someone who one would have expected to have been more caring. For instance, several incidents have occurred where women have suffered debilitating pain from endometriosis, but their concerns were ignored by their physicians. Similar incidents have occurred for women patients, where it was eventually found that they had cancer, and were not experiencing any sort of psychosomatic illnesses. Some women patients have even had their heart disease mislabelled as anxiety, while others have had their pain due to ovarian cysts dismissed as usual period pain. One study found that in an emergency room context, women were having to wait 33% longer than men, even when they had the same symptoms of severe stomach pain. The amount of suffering those women patients had to endure could have been reduced if not altogether eliminated if only their attending physicians had embraced the principle of amanitvam and truly listened to them, instead of making their minds up without even acknowledging their patients’ concerns. Many other physicians simply refuse to acknowledge the pain threshold of their BIPOC patients. 7 A lot of this stems from false and stereotypical beliefs about biological differences between white and black people. These false beliefs then manifest in racial bias in pain perception, which in turn is associated with racial bias in pain assessment and treatment recommendations. In this scenario too, some humility from the physicians would have perhaps helped them truly listen to their BIPOC patients, and acknowledge their genuine concerns and symptoms. It takes humility to cast aside one’s previously held notions, and acknowledge another person’s perspective. Similarly, many times individuals suffering from Lyme disease get misdiagnosed as having unrelated psychiatric illnesses. It is quite conceivable that pride is causing some doctors to overestimate their personal knowledge, and therefore, lead them to ignore what their patients are telling them. Instead of telling someone that it is all in their head, why not follow through with more kindness, and truly listen to the suffering individual? After all, only by truly listening can one begin to start to become more accurate in making diagnoses. Amanitvam is a quality that would help physicians learn to truly listen to their patients, even if the patient is from a completely different strata relative to the physician’s own social status and profile. Only by truly listening to one’s patients, can a physician be able to understand how to proceed with an accurate treatment plan. One needs at least a modicum of humility to begin to comprehend that one could be harbouring false beliefs and biases, which could be resulting in racial and biased disparities in treatment. An individual needs humility in order to achieve selfawareness, and only by becoming aware of one’s own deficiencies, can that individual hope to start correcting himself or herself. Amanitvam can help with that by imbuing the belief that needless pride can hamper treatment and diagnosis quality. As explained above, this word amanitvam from the Bhagavad Gita is a word that has a great deal of applicability in a medical ethics context. I also believe that this word and the principle it espouses (ie, humility) can help in improving the overall climate of medical ethics.