Jain Medical Professionals’ “Reflexive Ethical Orientation”: Adaptive Nonviolence, Multiple Sources of Knowledge, and Concern for Five-Sensed Beings

Round 1

Reviewer 1 Report

Dear Editor, dear Author, This article is an important contribution to the literature because it introduces Jainism, an often overlooked but in terms of ethics highly interesting tradition, into the discussion, and also because it shows more generally the importance of extending reflection on religion and medicine/ care beyond the theistic or worship-based categories that still often are considered as the natural framework. In the Religious Studies classroom, when teaching about a tradition, the instructor faces the challenge of deciding if the attitude of tradition x to topic y is something that should be taught with reference to scripture and other authorities or by looking at what the practitioners of that tradition actually believe and do, or a combination thereof. This paper points towards the interaction of tradition/authority and practice in contemporary plural contexts, which is vital for such reflections. For these reasons, the article will be of interest both for those specialising in Jain Studies and those in other fields relating to religion. It is an excellent fit for this journal.   The article is based on a survey that questioned Jain medical practitioners on the relationship between their Jain identity and their medical practice. The methodology and results are presented clearly. Obviously, the issues that are raised in the survey would require more in depth research and a more detailed analysis, but as the author's intention is to bring Jainism into the discussion and to open a debate, such a broad approach is justified as it shows several openings which other studies could use as starting points.   My feedback: The paper starts by indicating a rise in interest in religion impacting on health. The latest literature in this section, however, dates back ten years. Here some more recent sources could confirm that this is indeed a discussion with ongoing relevance. The short introduction to Jainism is sufficient in scope and provides the necessary background. Generally I found the explanatory sections well done, as they provide sufficient information without being too long. I also like that the questionnaire that was used for the survey was designed in collaboration with Jain physicians because thisindicates an approach to social science that takes the community perspective seriously as a potential corrective for the (presumably outsider) researcher.
One of the secondary research questions of the survey was "1) Does the Jain tradition influence the kind of profession one takes?". I felt that the "one" here makes the question unnecessarily ambiguous. Why not ask if it influenced the participant's career joice? Obviously not something that can be changed now, I was just wondering.
In line 206, the author explains the use of the term "reflexive" in relation to the Jain approach to medicine by referring to Sha's use of the term in 2014. I very much agree that the term is applicable and useful. The observation that Jains construct their identity by engaging creatively with their ancient tradition dates, however, back far further, such as the concept of flexible fundamentalism in Chapple, Christopher. 1993. Two Traditional Indian Models for Interreligious Dialogue: Monistic Accommodationism and Flexible Fundamentalism. Dialogue & Alliance 7: 18–30. See also footnote four in Frazier, Jessica. 2021. Ethics in Classical Hindu Philosophy [...]. Religions 12: 1029. The section on interventionism starting in line 400 is very interesting and could be expanded into a new article some time.   Some minor remarks: In line 326 there is a superfluous apostrophe behind the first word. Maybe it is just on my screen but the font in the paragraph starting 357 appears inconsistent. I did not understand the point of (“Jainism”) in line 449. The sentence starting 494 should be checked for grammar.   I enjoyed reading this article.

 

Author Response

Dear reviewer, 

Thank you for taking the time to review this article. My responses are below.

1. Your suggestion to review more recent articles on religion and physicians and patients is well taken. While most of the available work is over ten years old, I was able to add two more on physicians, and one more recent meta-study in relation to a source I already included. These dates validate the need to revive this conversation on a multicultural stage
2. Survey question language is taken directly from the survey itself so any limitations must remain to accurately reflect what respondents saw when taking the survey
3. I added a fn referencing Chapple's "flexible fundamentalism"; thank you for bringing that to my attention
4. I adjusted the stray apostrophes after "Respondents" in the location you noted and elsewhere.

Thanks very much for your feedback.

 

Reviewer 2 Report

This paper makes an important contribution to ethical decision making conversations that, importantly, include perspectives from nontheistic religion populations. It shows that Jain principles and practices that are rooted in the Sanskrit constructs are enacted in reflexive and pragmatic ways by the participants. This paper will potentially garner interest from the journal's readership, and I offer these comments to render the paper potentially more engaging. Consider refining the title e.g. Jain Medical Professionals Reflexive Ethical Orientation: Adaptive Nonviolence, Multiple Sources of Knowledge, and Concern for Five-Sensed Beings. There is a suggestion that participants may have recorded instances of their experiences and some inclusion of these tensions in each of the sections would enrich the discussion e.g. instances of derision; refusal to participate in animal 'experiments'; or even some justifications for use of antibiotics. I recognise that this has been icuded in part but a clearer participant voice would, in y opinion, add strength to the inductive reasoning that the author espouses. It is not clear whether the participants withhold choices from patients, and should this be part of the data set this point should be added.

At times I found the quantified percentage data confusing or expression be made more clear e.g. l 161 -172. I suggest that all percentages have the number of respondents included (as is the case throughout most of the paper). Alternatively, incorporate the items or minority perspectives from the participant pool into the narrative of the paper. This will also indicate reflexive ethical orientation.

Typos l228 and  l425 and check wording of quote l472. Aim for staight forward expression in a final edit.

Author Response

Thank you for taking the time to review this article. My responses are below.

1. I've repaired the noted typos on L228 ("On one hand"), L425 (mediation to meditation)
2. I repaired question on L472 (is my to in my)
3. I went through the paper to ensure the reviewer's suggestion "that all percentages have the number of respondents included (as is the case throughout most of the paper)". I was able to add some of these numbers in for clarity. *When a set of responses is in the same sentence, I only list the number of responses one time. I restate the number of response when/if a new sentence begins. 
4. I did opt to include some additional free responses from respondents thanks to the reviewer's suggestion, including fn 15-16
5. Also, on p. 14-15, I added a section: 

   Among the various responses describing these conflicts (n = 34), I include a few here to highlight the respondent voice: “When patients are advised to eat non-veg food, the modern scientific knowledge is not looking at holistic approach whereas Jainism emphasizes harmony for all”; “drug testing and testing of experimental drugs/devices on animals”; “animal autopsy”; “how to test new medical treatments without injuring animals or innocent humans”; “I refused to take part in dissection at school anatomy. Now it is better as [students] can have [project-based learning] and computer-based learning”; “[I]n terminally ill patients - I wish people [would] accept the end and practice modified sallekhanā and not have desire to hang onto life when physicians can’t do more”; “I believe in evolution and sometimes Jain principles do not align with the evolution theory”; “giving out flu vaccines cultured in egg yolk to meet corporate goals”;  “Abortion. Animal products in drugs. Euthanasia”; “difference in the definition of death: Jainism believes that leaving in vegetative state prevents the liberation of soul when scent wants to prolong that”; “Jain geography and reincarnation”; “I don’t think Jain principles conflict with modern science. In India, Jains own more pharmaceutical business than any other religion which [is] the point of science.”

6. I am also opting to change the title per the reviewer's suggestion to Jain Medical Professionals' "Reflexive Ethical Orientation": Adaptive Nonviolence, Multiple Sources of Knowledge, and Concern for Five-Sensed Beings

Thanks very much++