Why I Wrote Passive Patient Culture in India: A Reflection

By Supriya Subramani

“In India, poor people and marginalised communities are often treated in an abominable way. They are ignored, slighted, blamed, cheated, humiliated – the list is not difficult to extend. This is also true to a varying extent around the world, but India is quite extreme when it comes to what Supriya Subramani aptly calls “everyday indignities”. One reason for this is the pervasive influence of the caste system, a uniquely oppressive structure of graded inequality.

There is a misconception among the privileged that the victims are used to being treated that way and take it in their stride. Nothing could be further from the truth. Most people aspire to some dignity, and every act of disrespect adds to the deep well of anger among marginalised groups.

Everyday indignities abound in all spheres of Indian life, but they are especially pernicious in the field of healthcare. As eminent economist Kenneth Arrow explained long ago, the relation between doctor (or nurse) and patient is based on trust. Disrespect on the part of the doctor or nurse can easily destroy this trust. As Subramani writes, it can even happen that “a Dalit man refuses treatment because of the humiliation he anticipates at a government clinic” – I have heard of specific examples of this myself. And this breach of trust is just one aspect of the debilitating effects of disrespect in a healthcare system based on the “passive patient” culture.

Supriya Subramani’s book is a pioneering attempt to explore this dark side of Indian healthcare. The study is enriched by her own experience of everyday indignities from childhood onwards. The book will be of much interest to privileged and underprivileged readers alike. For those who have also been at the receiving end of everyday indignities, it will be a source of strength and inspiration. If you come from the other end, this book will help you to open your eyes to patterns of disrespect that are too often taken for granted.”

— Jean Drèze

When I began writing Passive Patient Culture in India: Disrespect in Law and Medicine, I wasn’t simply compiling fieldnotes or theorizing from a distance. I was reckoning, with lived experiences, fragments of memories, voices of patients and caregivers, healthcare professionals, and with a medical-legal system that too often treats self-respect and dignity as expendable. I was sitting with narratives of being ignored, dismissed, silenced. And I found myself returning to a question: why is it so crucial to take recognition and self-respect seriously in our conversations about health, ethics, and politics? This book emerged from that question, and from the layered, entangled realities of patients, families, healthcare professionals, and my own encounters with institutional care.

There is a dull, persistent cruelty in how everyday life unfolds for the marginalized in India. Healthcare, which should be a space of dignity and care, too often becomes a site of humiliation, where people are blamed, overlooked, or shamed. And because these indignities are so pervasive, they’re normalized. Sometimes, it’s the curt tone of a nurse, the raised eyebrow of a doctor, the wave of a hand dismissing a patient’s concern. These may seem minor, but they accumulate. During my fieldwork, I saw again and again how the bar for being treated with dignity had fallen so low that the mere absence of abuse was perceived as good care. When people begin to expect—and internalize—disrespect as part of seeking help, we have to ask: what kind of healthcare system have we built? And what kind of society are we sustaining?

At the heart of this book is a focus on what I call the culture of disrespect—a systemic condition in which patients are rendered “passive” through institutional, professional, and social hierarchies. Across chapters, I trace how the archetype of the passive patient is not simply a cultural trait, but a product of embedded power structures—deeply shaped by caste, class, gender, and dominant institutional ethos. Through an interdisciplinary and critical philosophical-qualitative approach, I examine how this archetype intersects with everyday indignities, dehumanization, and the normalization of disrespect in India’s healthcare and legal systems.

Foregrounding disrespect as a central ethical concern, not merely a communication issue or procedural flaw, was my primary intention. This is my contribution to ongoing conversations in health ethics, particularly in India, but also globally, where the ethical weight of disrespect remains underexplored. So, when I read Jean Drèze’s generous reflection on the book, it offered a quiet reassurance. His words, that Passive Patient Culture in India could be “a source of strength and inspiration” for some, and “an eye-opener” for others, echo the very hopes I had while writing. I deeply admire Jean’s work, and his recognition affirmed the intention with which I approached this project: to illuminate, to question, and to refuse what we have too easily come to accept.

As someone working across disciplines, I’ve grown used to the friction that comes from resisting neat academic categories, and often question the gatekeeping practices in some spaces. In this book, I move between methods and epistemologies, often irritating the gatekeepers of disciplinary purity. But my aim was never to present “passive” and “active” patienthood as fixed or universal categories. Rather, I offer them as conceptual tools—fluid and provisional—that help us reflect on how power, recognition, and institutional practices shape patienthood.

I also want to emphasise that this book sits in the messy in-between, where theory meets narrative, where structural injustice confronts everyday life, and where research becomes a form of witnessing. I explicitly frame my approach as a critical philosophical ethnography, and while the form may not satisfy every disciplinary checklist, it is rooted in a commitment to listening—especially to voices pushed to the margins. Rather than offer a checklist of marginalizations, I try to show how various forms of structural and symbolic violence converge. The aim is intersectional attention—to how caste, class, gender, and bodily norms entangle in shaping how one is seen (or not seen) as a patient, as a person. One of the most not surprizing realizations during this work was that ideals like informed consent, autonomy, and procedural ethics—so often celebrated as universal principles—were barely visible in the hospitals I visited. In these contexts, consent was less an ethical process than a performance—one where power was asymmetrical, communication fragile, and trust precarious.

Over time, I came to see that what was missing was not just a legal safeguard—it was something deeper: a crisis of respect. Bioethics often treats the passive patient as a barrier to autonomy. But what if passivity is not a trait? What if it’s a survival strategy—or an identity imposed through repeated acts of disregard? This is what I trace in the book: how the figure of the passive patient is culturally and institutionally maintained. It becomes a way to locate failure in individuals, rather than in the systems that produce such resignation.

As Jean Drèze reminds us, the belief that people “get used to” mistreatment is a dangerous myth. It absolves those in power. It disguises structural violence as cultural apathy. But people do not get used to being disrespected. They endure it. They carry it. And they long to be treated with dignity. That is not too much to ask. But ethical repair cannot come from a checklist or a training session. It requires deeper change—structural accountability, relational attentiveness, and a radical reimagining of what it means to offer care.

To reiterate, what I expressed in the book, I hope this work is received “as a retelling that had to happen, a gesture of hope, a spark for conversation, a space where rage and grief find voice, and perhaps a testament to the deep suffering and humiliation within our health and legal systems… this work is an act of ethical imagination, a way to shed light on how the process of othering unfolds, and to remind us that disrespect is not a distant issue to be dealt with later, but an urgent moral crisis, a barrier to living with self-respect and true dignity.” I hope that scholars and practitioners who are already questioning disciplinary parochialism will find something in this book that resonates, and that it offers a small push toward the broader pursuit of justice, dignity, and social change.

Passive Patient Culture in India: Disrespect in Law and Medicine

In a society shaped by deep inequalities, where healthcare and legal systems often reinforce class, caste, religion, and gender hierarchies, this book offers a powerful examination of patienthood in India. Through its critical approach, it seeks to disrupt binaries—such as universalistic and particularistic values and data versus theory—while decentering normative discourses by foregrounding lived experiences within the context. It offers philosophical and conceptual insights that extend far beyond local variations and contexts, challenging dominant narratives in global discourses on medical decision-making and concepts such as informed consent, autonomy, and respect.

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