Cultivating a ‘Habitus of Multiplicity’ in Cross‐Cultural Medicine: From Case Study Conflict to Many‐Sided Conditions of Care Through Process and Jain Metaphysics

ABSTRACT

Prompted by a nursing case study that occurred in 2022, this paper joins the perspectives of a nurse practitioner and cross‐cultural medical ethics professor to consider who can ask a question in the healthcare system, what questions can be heard, and how to develop pluralistic care models—beyond relativism and imperialism—that solicit more diverse experiences and inquiries. Specifically, I utilise the metaphysical concepts of Alfred North Whitehead's ‘actual occasion’ alongside the ‘many‐sided‐view’ (anekānta‐vāda) from the Jain tradition of South Asia to theorise a processual ‘habitus of multiplicity’ by which healthcare professionals, especially nurses, engage with and as a many‐faceted event. As event, cultivating this ‘habitus of multiplicity’ is akin to a perceptive mode that: (1) anticipates the complex ‘who’ of each individual patient and provider as creative powers‐in‐process, (2) solicits novel inquiries between patients, providers, and health systems, including those previously ‘unheard of’ in dominant frameworks, and (3) promotes procedural efforts to mutually pluralise, rather than relativise, non‐hierarchical care models.

1. Case Study

A family of unknown Asian origin asks the critical care Nurse Practitioner (NP) to sew up tracheotomy and feeding tube incisions on the body of their deceased adult father. Despite the language barrier, the family clearly conveys that sewing up these ‘holes’ as soon as possible is extremely important to them, although the reason why is not clear to the NP. Although standard hospital practice is to leave any post‐mortem procedures to the funeral home or coroner, the NP feels compelled by the family's wishes in a time of loss, and the commitment to ‘whole person’ care that characterises the faith‐based health system she is functioning within, and agrees to the family's request. Soon after, feeling that she may need to justify her decision to others—possibly incoming bedside nurses, the attending physician on duty, hospital administration or the legal department—the NP contacts a professional colleague who teaches Asian religions/philosophies and cross‐cultural medical ethics at a regional university to see if the family's concern over stitching surgical openings might be ‘religious’ or attributable to some other ‘cultural’ reasoning that can fit within the standard principles of biomedical ethics.

This case invites readers beyond the typical dilemma of medical case studies to positively theorise and practice a processual ‘habitus of multiplicity’ through which healthcare professionals, especially nurses, engage with and as a many‐faceted event. Specifically, I demonstrate how the metaphysical concepts of Alfred North Whitehead's ‘actual occasion’ alongside the ‘many‐sided‐view’ (anekānta‐vāda) from the Jain tradition of South Asia function as perceptive and open‐ended modes for: (1) anticipating the complex ‘who’ of each individual patient and provider as creative powers‐in‐process, (2) soliciting novel inquiries between patients, providers, and health systems, including those previously ‘unheard of’ in dominant frameworks, and (3) promoting procedural efforts to mutually pluralise, rather than relativise, non‐hierarchical care models.

The above event took place in 2022 and resulted in ongoing conversations between the NP (hereafter NP) noted in the case and me, the Asian Religions/Philosophies professor who also teaches cross‐cultural medical ethics at a nearby university. By definition, the etymological root of ‘dilemma’ denotes a choice between two unfavourable argumentative alternatives (from Greek di‐ ‘twice’ + lemma ‘premise’), frequently expressed in case studies as an individualistic moral decision between ‘do X’ or ‘do not do X’. In the above case, one might position the NP's dilemma as ‘to sew or not to sew’ the incisions.

But in fact, the NP's decision to suture the surgical holes was almost immediate and presented her with little, if any, moral question. Her intuitive agreement—when she examined it in hindsight—likely reflected, in part, her closer professional proximity with the patient and their family, her desire to make dying and death a bit better for them, her training to consider patient health as a multi‐dimensional aggregate of individual, family, and society, and her philosophical alignment ¹ with the health system's faith‐based foundations to provide ‘whole person’ care. ‘What could more tangibly represent the ‘whole person’ vision of health than honouring a request to stitch up holes?’ the NP later mused during one of our conversations.

The moral dilemma arose, rather, when the NP considered (a) what, if any, atypical questions can be asked of the healthcare system, (b) what, if any, novel actions can take place within the ‘standard of care’, and (c) what, if any, justifications must be made within that system—by and to whom or what—in order to respond nimbly and confidently to such questions of vital wellness.

2. The Need for More Dynamic Cross‐Cultural Care Models

Cross‐cultural patient care presents novel scenarios, like the above case, that don't fit neatly within existing institutional structures and ethical frameworks. The move to multicultural medicine recognises a considerable error in assumptions around a ‘common morality’ within a unified ‘society’ that undergird both principle‐based health care ethics and case‐based approaches (Azétsop and Rennie 2010; Coleman 1998; Engelhardt 1991; Hern et al. 1998; Koenig and Gates‐Williams 1995; Michel 1994; Turner 2003). The four principles laid out by Beauchamp and Childress (2001) in their 1979 Principles of Biomedical Ethics—including respect for autonomy, non‐maleficence, beneficence, and justice—remain operative in medical training and ethics consultations, even as they presume a limited, and peculiarly ‘Western’, sense of liberal individualism. Likewise, covenant‐based alternative to principles—put forth in the early phase of medical ethics as a Western discipline by religious ethicists such as Paul Ramsey's The Patient as Person (1970), maintain a Judeo‐Christian‐based approach to responsive care between covenantal pairs of individuals such as physician and patient, researcher and ‘subject’, adult and child, the living and the dying (1970, xlv).

Multicultural medicine aims to develop ‘cultural competency’ and ‘cultural humility’ beyond a primarily Western or Judeo‐Christian framework recognising, that ‘[b]ioethical concerns are global [but] bioethics is Western’ (Chattopadhyay and De Vries 2008). On one hand, such a claim accurately captures the common conceptual and geographic narrowing of ‘bioethics’ into a medical‐only discipline emerging in the United States from the 1960s to the present. On the other hand, the earliest—and often overlooked—references to ‘bioethics’ are actually much broader than contemporary usage, a fact that supports ongoing global and expansive re/interpretations. For example, German Protestant minister and ethicist Fritz Jahr (1895–1953) first coined the term ‘Bio‐Ethik’ in the early twentieth century as a disciplined activity cultivating healthy human and nonhuman biotic relationships (Jahr 1926; Jahr 1927), resulting in his ‘Bioethical Imperative’ to ‘Respect every living being in general as an end in itself and treat it, if possible, as such!’ (Jahr 2013, 21). A second known use of the term came from Van Rensselaer Potter (1911–2001), an American biochemist and oncologist often credited with coining the term ‘bioethics’ in his 1970 article ‘Bioethics, the Science of Survival’. Like Jahr, Potter envisioned bioethics as an activity. The term encompassed medical ethics as well as environmental, global, and intercultural ethics, as a mode of constructing what Potter called a ‘bridge to the future’ joining biology and values, scientific knowledge and human wisdom (Ramsey 1970, 128). Moreover, the last forty years have seen increased non‐Western scholarship on bioethics with several thematic texts in Hindu, Buddhist, and Jain approaches among others. ²

A multicultural approach to ‘patient‐centred care’ requires perceptive efforts to respect myriad relations of ‘patient and family preferences, values, cultural traditions, language, and socioeconomic conditions’ (Stubbe 2020). Certain health systems encode multicultural medicine into ‘holistic’ or ‘whole person care’ frameworks (Gober and McMillan 2014; May 1983; Meilaender 2005), exemplified by the faith‐based hospital in which the NP in the above case is employed, and described from the hospital website here:

Our approach to patient care is to treat the whole person, including physical, emotional and spiritual needs.

As part of our commitment to your health and healing, we seek to learn about your personal spiritual needs not just your medical history. During your patient experience, you might be asked about your sources of strength, outlook on religion and beliefs, and current support systems.

We want to have a better understanding of your life experiences and the role of spiritual experience or values in illness and health. Our providers are trained to guide conversations that engage the whole person.

(‘Our Approach’ 2024; emphasis added)

Alongside advocates pushing for national standards of culturally competent care and improving cultural proficiency in medical training (Pamies and Nsiah‐Kumi 2006), structural efforts such as the Patients' Bill of Rights (1997), increased use of medical interpreters, and mandatory training to identify sexual harassment, discrimination, and hostile workplace, all provide varied mechanisms to broaden diversity awareness in healthcare settings. The case study provided shows how cross‐cultural medicine unfolds in unpredictable clinical moments where healthcare professionals might benefit from theorising their perceptive modes in novel scenarios.

3. Perceiving Multiplicity in Process and Jain Metaphysics

‘Metaphysics’ is a term signifying an ultimate conception of the nature and structures of reality. Often metaphysics can be presented as (1) ‘monist’—meaning that all apparent differences are reducible to some kind of oneness, be that electric vibrations, ‘matter’, or ‘soul’, or (2) dualist, as in the well‐known duality of French philosopher and scientist René Descartes (1596–1650) that all reality consists of either mentality or materiality; that is, immaterial mind/soul substance with no observable presence and material substance measurably extended in space. There are several global metaphysical systems, and even monist and dualist views can be more or less dynamic and relational.

Two such dynamic metaphysical systems that emphasise multiplicity and the aim of widening, many‐sided perception—rather than monism or dualism—are Process‐relational philosophy, also called Process Philosophy of Organism, associated with the English mathematician Alfred North Whitehead (1861–1947; (hereafter ‘Process’) and the South Asian tradition of Jainism, rooted in ancient India, now with diaspora communities around the world.

Whitehead suggests that what is really real in the universe is not fixed substances of being, but rather processive events of becoming, that he calls ‘actual occasions’, referring to ‘the final real things of which the world is made up’; he continues, ‘There is no going behind actual [occasions] to find anything more real’ (Whitehead 1978, 18). The actual occasion is an instance of unification, or ‘concrescence’, between existent data and future possibilities; the becoming occasion feels, or ‘prehends’, existing data and possible potentials, in a ‘subjective aim’ toward novel, non‐deterministic, actuality (19). This becoming does not happen within space‐time, Whitehead makes clear—as argued by earlier materialist views of space as a container in which atomistic things float around in metered succession; rather, every event produces the ‘extensive continuum’ of space‐time through its becoming concrescence (66ff). To restate the point, the perceptive mode of concrescence is equivalent to what exists, or as Whitehead states, ‘how an actual entity becomes constitutes what that actual entity is… Its “being” is constituted by its “becoming”. This is the “principle of process”’ (PR 23; emphases original). In this view, perceiving and unifying multiplicity toward a possible becoming describes a perceptive, open‐ended mode—the how—for determining existence.

Organisms—including nurses, but also cells and stones and birds—consist of many coordinated actual occasions and are called ‘societies of occasions’, or more simply, ‘nexus’, or nexūs, plural (20ff). The principle of process—where the how, as a perceptive and open‐ended mode of becoming, determines what exists—is multiplied in these complexifying organisms. Importantly, while consciousness or cognition can emerge from complex becoming, those capacities are not essential in the process of concrescence, which pervades the entire universe (52–53). Instead, the primary activity of existence is nonconscious feeling, or ‘prehension’, both of given data and possible potentials, toward wider modes of ‘contrast’, (29, 114) explored in Whitehead's unique concept of Beauty, of which each event can be more or less inclusive of intense, multiplicitous, data and potentials (Whitehead 1967, 252ff; Henning 2005).

Likewise, the Jain tradition, which emerged in dialog with varied perspectives in the Indian subcontinent—including Vedic, Buddhist, materialist, and other metaphysical streams (McGovern 2019)—posits a dynamic relation between substance and change. Relevant to this analysis, Jains also have a historical medical tradition alongside guidelines for Jain ‘householders’ (vs. ascetic monks and nuns) to pursue less harmful occupations, which came to include medicine (Stuart 2014). As a result, contemporary lay Jains having relatively high representation in medical fields, as explored in recent studies (Chapple 2014; Donaldson 2019; Donaldson 2022; Donaldson and Bajželj 2021; Jain 2024; Shah 2019).

In Jain view of what is really real, every existing entity—from minute components aggregated together to complex organisms—houses a distinct core life force, or substance, called jīva, with qualities of pure knowledge/perception, energy, and bliss (inward stability); ³ these qualities undergo continual modal changes through activity, or material karma (Donaldson and Bajželj 2021, 16ff). This ontological affirmation that every existent is equal in its perceptive‐but‐obscured core that is always undergoing modal change provides the logical foundation for the Jain ethical practice of nonviolence, or ahiṃsā, toward all living things.

The reality of Jain metaphysics posits a dynamic relation between permanence and change, effected by ongoing activity, as it occurs in an infinite multiplicity of actual, ultimate jīvas. Not only is each equal jīva unique due to its own change‐producing action of cognition, speech, and/or body, but to perceive rightly in such a dynamic universe means to identify both the permanent inviolable aspect of existence as well as the ongoing changes unfolding moment to moment.

4. Perceiving Multiplicity With Less Exclusion

Both of these metaphysical accounts—because of their underlying view that reality itself is not simply either singular or dual, but truly multiplicitous and dynamic—require an ongoing perceptive encounter with reality. Much of this perception may occur beyond the level of conscious awareness, but both accounts also invite, whenever possible, an active, perceptive and open‐ended mode of increasing the inclusion of/coexistence with other existents, alongside decreasing obstruction and violent exclusion.

For the Process perspective, reality is nothing but actual occasions, sometimes in coordinated nexūs—including oneself as a nexus organism—prehending diverse data and possible potentials in a novel becoming that adds its unique determination to the whole. As Whitehead says, ‘The many become one, and are increased by one’ (Whitehead 1978, 32). The becoming of each occasion (and nexūs of occasions) is a dipolar fusion between the given limits of available physical data and a virtual unlimited possibility of unbounded prehension without loss. ‘Judgement’, writes Whitehead, ‘is a process of unification’ between particularity of existence and ‘the totality of existence’ (Whitehead 1948, 62), a totality described in Process and Reality as ‘that of a tender care that nothing be lost or excluded’ (PR 346). This means that each individual becoming decides itself through prehensions of data and potentials that ‘minimise obstructive modes… [toward] a complex structure of harmony’ (PR 340) thereby ‘convert[ing] the opposition into a contrast’ (PR 223). As it relates to the case study in question, the NP perceived a novel request emergent from several more‐or‐less apparent family factors within a given structure. The NP's attempt to perceive and integrate, rather than merely reject or exclude, several of these novel elements exemplifies how many factors—past, present, and potential—become a truly new expression of contextual care.

In Jain perspective, reality consists, in part, of infinite jīvas undergoing constant modal change through activity. Right perception of this multiplicity—both in self and others—requires a perceptive simultaneity known in Jain logic as ‘non‐one‐sided view’, or anekānta‐vāda —which is also positively stated as ‘many‐sided view’. This applies to Jain ontology, wherein anekānta‐vāda means that ‘any existent must be understood on three levels [simultaneously]: the modes, which last only a moment and belong to the qualities; the qualities, which undergo changes and yet inhere forever in their substances; and the substance [jīva], which remains the abiding common ground of support for the qualities and their modes’ (Jaini 2001/1979, 90). ‘Many‐sided view’ also describes a Jain epistemology complex ⁴ acknowledging, first, that every view or mode of existence, called a naya, is a partial perspective, and second, that the best view will be one that can evaluate and/or integrate as many of these partial perspectives as possible.

Jains use a version of ‘The Blind Men and the Elephant’ pan‐Indian fable to express the multi‐dimensionality of complex reality and the related attempts to know it more fully (Barbato 2017, 44). The blind man who feels the elephant's leg says it is like a pillar, the one who feels the tail says the elephant is like a rope, the one who feels the trunk says the elephant is like a tree branch, and so on. Each of these perceiving ‘blind men’ represents different nayas, or partial perspectives; the logic of anekānta‐vāda suggests that multiple nayas must be coordinated together to get closer to complex reality or truth. As it relates to the case study, the NP's bedside encounter presents an opportunity to piece together more partial perspectives, including the abstract rules of a healthcare structure that govern day‐to‐day rounds, with the unique points of view of a particular patient and his family members expressed in a request to suture holes. The NP can retain a partial view of what is typically allowed, or take up certain other perspectives on a many‐sided event.

With this brief introduction of perceptive modes in the Process and Jain metaphysical systems of multiplicity, I return to the case study to theorise aspects of a ‘habitus of multiplicity’ by which healthcare professionals, especially nurses, can engage with, and as, a many‐faceted event in the contextual conflicts of cross‐cultural medicine.

5. Cultivating a Habitus of Multiplicity in Cross‐Cultural Medicine

A ‘habitus of multiplicity’ is an experimental term that I draw from diverse contexts to describe a perceptive mode of engaging multiplicity with, and as, a many‐faceted event, beyond the limits of current healthcare structures and ethical frameworks. The French sociologist Pierre Bourdieu defined a ‘habitus’ within his Outline of a Theory of Practice (Bourdieu 1977), as ‘a subjective but not individual system of internalised structures, schemes of perception, conception, and action common to all members of the same group or class’ (86). Basically, Bourdieu's ‘habitus’ describes a mode of thought and action unreflectively shaped by and within a social field of expectations, norms, and judgements. A similar idea exists within a South Asian context, wherein ‘habitus’ is equated with a conditioned embodied sensibility. Buddhist studies scholar Justin Fifield equates the re‐training of such embodied sensibilities with śīla, or the moral precepts articulated in early Buddhist monastic texts, that are meant to overcome inherited dispositions through practicing new forms of ‘habitus’ (Fifield 2019, 261–64). I will delineate aspects of a reoriented habitus of multiplicity in the below sections.

5.1. ‘Who’ Asks a Question in a Health System? Cultivating a Habitus of Anticipating Multiple Powers‐in‐Process

One of the foundations of Western medical ethics is the concept of patient autonomy, or self‐governance that is free of coercive restraints. Emerging most saliently in international guidelines following egregious medical abuse of prisoners in World War II concentration camps, guidance in The Nuremberg Code (1947) and The Declaration of Helsinki (1964) emphasised patients' informed consent and ability to withdraw from or refuse medical procedures for any reason. Because the individual personhood and desires of patients had been so drastically violated in these and other healthcare harms, the centrality of respecting personhood‐as‐autonomy became foundational in the patient‐physician relationship, and remains the ostensible bedrock of modern bioethical principles for receiving or refusing care.

The ‘who’ of autonomy, however, remains problematic, both in cross‐cultural views of the individual and, more intractably, in stagnant healthcare hierarchies. The above case study raises two primary challenges to autonomy for which a processual habitus of multiplicity can apply: the ‘who’ of the patient and ‘who’ of the nurse. In this case study, a request related to the deceased father as a patient comes from a family member, when the son asks the NP to sew the incisions. When a patient is non‐communicative, the role of a family member, or another surrogate decision maker, is accepted as a proxy for the patient. In this case, however, the request to suture holes was not a normative proxy request in the standard of care for deceased patients, as we'll see in the next section, but was rather a novel inquiry for an additional action.

Nevertheless, the NP opted to extend patient autonomy beyond the individual to other family or kin relations, demonstrating clinical awareness of an increasingly common critique of autonomy‐as‐only‐individualistic. Because diverse cultural accounts posit autonomy differently, such as ‘collectivist’ (Naramore and Marquez 2024) or ‘autonomy connectedness’ (Moleiro et al. 2017), the applications of bedside autonomy are increasingly recognised as more entangled, such that a patient's ‘self’ is understood through its social relations and not fully distinct from them.

Process and Jain metaphysics both support this corrective of cross‐cultural medicine by challenging the notion of a fixed ‘subject’ as an individual‐always‐present‐to‐itself. As though to anticipate the late twentieth‐century deconstructions of ‘the subject’ in Continental philosophy, Whitehead—who straddled the previous century—already rejected the view of a ‘subject’ solidified in Descartes' cogito ergo sum, ‘I think, therefore I am’, which, as Whitehead puts it ‘requires nothing but itself in order to exist’ (Whitehead 1978, 59). He replaces this view of a pre‐existing subject perceiving inert objects with the actual occasion that is internally constituted by prehending, or feeling, other occasions‐as‐data within its own becoming (PR 41). Anything in existence, says Whitehead, is ‘determined by its internal relations to other actual [occasions]’, both through prehending those occasions in or out, and also by becoming a potential object for the prehension of other occasions (PR 59). An occasion, while distinct in how it prehends a selection of data, is nonetheless (1) ontologically constituted by other prehended occasions in the subjective aim, and (2) contributes itself to the creative arising of other events as objective datum, and through this, Whitehead claims, ‘Everything has some value for itself, for others, and for the whole. This characterises the meaning of actuality’ (Whitehead 1966, 111).

Similarly, the Jain perspective offers an ancient metaphysical claim that the unique ‘who’ of each infinite substantive jīva is always undergoing persistence and transition based on its activity. As noted above, Jain anekānta‐vāda, or ‘many‐sided view’, is required by this ontological dynamism, such that every existent is an irreducibly singular perspective, or naya, of reality. Anticipating the unique social constitution of each patient, even a recently‐deceased patient, is an essential practice in cross‐cultural medicine.

The less visible aspect of autonomy in this case, is the ‘who’ of the NP in relation to the dominant bioethical framework and structural hierarchy she is functioning within. While a dilemma is often positioned as two competing premises debated in the mind of the singular moral agent, the problem in this case actually arose between the NP and wider structures of power, namely, the possible dispute with the attending physician, hospital administration, or legal team.

In his work on hospital ethics, sociologist Daniel Chambliss describes medical ethics as distinct from nursing ethics, with the former unfolding among powerful people and the latter taking place among less powerful people, specifically nurses (Chambliss 1996, 87), who work at the junction of multiple ‘occupational groups and moral ideologies’ (93). The issue of ‘moral distress’ in nursing is rarely, says Chambliss, one of a separate moral subject reflecting on distant philosophical principles, but rather describes the experiential strain of having to adaptively function within a powerful structure of abstract ideals: ‘the ethics of witness, not decision makers; the ethics of implementers, not choosers’ (87). Bioethicist Andrew Jameton sums up the problem of nursing ethics succinctly: ‘Moral distress arises when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’ (1984, 6). Much like the dilemma of this case, Chambliss write, ‘Nurses often say, “I know what ought to be done, but I can't get it done”’ (1996, 92).

Hence, a habitus of multiplicity highlights how the NP is creatively perceiving an adaptive and interdependent version of autonomy that ‘varies across cultures and across ethnic groups in the same society, and stands as a crucial trait that differentiates cultures in individualistic and collectivistic pathways of development’ (Moleiro et al. 2017, 23). At the same time, the NP is also a singular becoming of stability and change who ‘juggle[s] the orders of physicians, the needs of patients, the demands of families, the rules of the law, the bureaucracy of the hospital, and their own physical and emotional limits’ (Chambliss 1996, 93) within more powerful ‘structural conditions that [often] have produced the problem in the first place’ (92). Positing this case as a traditional moral dilemma overlooks the expansive, but subordinated, ‘who’ of both the patient and NP who strives to provide a relatively simple care act amidst structural obstacles.

5.2. What Questions Can be Asked? Cultivating a Habitus of Soliciting Novel Inquiries

In their work on traumatic colonial violence, María del Rosario Acosta López and Juan Diego Pérez Moreno describe how certain forms of harm are ‘unheard’ (inaudito) both in the sense of not being listened to, and also as unheard‐of in the current structures determining what is legible, believable, recognisable, and legitimate (Acosta et al. 2025, 107). In this case study, the son's request to have his father's incisions sewn up after death may not immediately equate to research on traumatic violence, but it's worthwhile to consider how the NP's dilemma was not with deciding the correct course of action, but with structures that may not approve the action as legitimate. ‘I was quick to say yes to this request, and to most any request I could help with’, the NP reported to me, especially given the recent removal of life sustaining treatment, the father's subsequent death, and her desire to support the family. The dilemma arose when the NP realised that this was a new question she had not heard previously and, consequently, might be unheard of, or unintelligible, in the available frameworks for healthcare ethics, including the whole‐person approach of multicultural medicine the NP was functioning within. ‘I've never been asked this question before’, the NP reported thinking to herself, ‘and I can't make this request easily fit into a framework that I'm already aware of. But it seems in my gut a very reasonable request’.

On one hand, the NP recognised that health systems do not accept all questions. While her own hospital's Christian mission claims, ‘Our providers are trained to guide conversations that engage the whole person’, those conversations are not truly open‐ended. Rather, such conversations solicit information within an existing framework of offering ‘appropriate’ care. As the NP suggested to me, ‘If we've already offered the standard of care, or over‐offered beyond what is obligatory and usual, there can be a reflexive feeling that additional requests are inappropriate’. Such requests might include a patient asking to have an unnecessary procedure, or seeking transport to a different health system for a second opinion on the hospital's dime. Other novel questions—such as wanting an additional specialist consultation, or wanting a pizza delivered beyond that day's cafeteria menu, or wanting incisions to be sewn up post‐mortem, as in this case—may be outside the norm yet still perceived as ‘reasonable’ in the nurse‐patient relationship.

In the face of this ‘unheard of’ question, the NP was confronted with a mismatch between her own gut reaction to a ‘reasonable request’ and the limitations of available frameworks to justify the action within the hospital structure. The NP realised that the particular attending physician on duty responsible for signing off on the death certificate might be unlikely to agree to any non‐standard post‐mortem interaction without sufficient justification given his own previous experiences with medical litigation; the hospital administration may decline since there is no policy on this specific scenario or because it could detract resources from other patient needs; or the in‐house legal team may reject any non‐protocol request as unnecessarily exposing the hospital to malpractice claims.

This mismatch resulted in the NP calling me, as the professor of Asian religions/philosophies and cross‐cultural medical ethics, to see if this request to close bodily holes might be attributable to a particular ‘religious’ or ‘cultural’ heritage. In so doing, the NP was trying to fit the request into ‘patient preferences’ within the bioethical principle of autonomy. Although such preferences cannot justify all atypical requests, the NP recognised that there is often a higher value placed on ‘religious’ or ‘cultural’ factors as uniquely informing patient preferences which, she candidly claimed, ‘make them harder to touch’, or refuse.

The NP's decision to seek such supportive reasoning gestures toward what philosopher Kristie Dotson calls a ‘culture of justification’ in which alternate Black or non‐Western philosophies—or in this case, alternate questions in healthcare ethics—must seek legitimacy by appealing to some univocal norms (Dotson 2012, 4–6). In my estimation as a religious studies scholar, I suggested to the NP that the son's request was likely derivative of hybrid cultural or community practices that did not fit neatly into any doctrinal ‘religious’ systems as such. It was not an essential ‘Buddhist’ practice, for instance, in terms of having a commonly known textual basis, though neither ‘Buddhism’ itself, nor its texts, are a monolith. Rather, many religious practices, texts, languages, and structures vary widely throughout the global locales into which they spread and continue to evolve. Various and syncretic death practices can be expected to emerge that don't fit easily even into a reductively ‘religious’ framework.

A perceptive habitus of multiplicity must find ways to seek and receive novel questions within the still‐limited linguistic frameworks of multicultural medicine. Whitehead's Process perspective was especially critical of what he called the ‘fallacy of misplaced concreteness’, rooted in the positivistic treatment of ‘nature’ as inert, passive, and easily definable, rather than a dynamic multiplicity of responsive and co‐constitutive becomings producing the emerging world that elude fixed description (Whitehead 1978, 7, 18, 93; cf. 111, 137). Likewise, anekānta‐vāda shows that even Jain thinkers in antiquity affirmed that no phenomena or term—such as permanence or change—could be taken as absolute. As described by scholar Melanie Barbato, ‘Jain ontology is therefore closely connected with a critique of the tendency of language to divide reality into neat philosophical boxes, which fails to accurately represent the richness and multi‐dimensionality of reality’ (Barbato 2017, 45). A positive mode of seeking and receiving questions—even if they press beyond the standard offerings of care—is an essential aspect of a processual habitus of multiplicity.

5.3. How Can (Structural) Responsiveness Grow? Cultivating a Habitus of Pluralising (Not Relativizing) Non‐Hierarchical Care Models

Cross‐cultural medical ethics often finds itself between charges of moral relativism—that rightness and value are fully context‐dependent—and moral imperialism—that rightness and value are measured only according to a single dominant framework (Beck 2015; Engelhardt 1998; Macklin 1999; Tosam 2020). In their challenge to universal bioethics, Subrata Chattopadhyay and Raymond De Vries argued that bioethics should be local, rather than global (Chattopadhyay and Raymond 2008, 108). A shift to the local makes sense, given the authors' meaningful correctives to even the baseline authority of the Hippocratic Oath that overlooks several similar, pre‐existing oaths in Indian Ayurveda, Chinese medical traditions, or indigenous healing practices, and how they have and might shape alternative health frameworks (107; cf. Kopel 2021).

Yet, a habitus of multiplicity moves further, beyond the global or the local to the multiple. ‘Be Multiplicity!’ writes Process proponent Roland Faber, as an invitation to emulate the expansive and non‐hierarchical process of becoming (Faber 2018, 207). Every actual occasion‐as‐event is an arising fusion of physical data with possible potentials, meaning a fusion of the real with the conceptual in non‐hierarchical mutuality, rather than the conceptual over the real in substance dualism. ⁵ Likewise, actual occasions are both subjects and objects that receive and contribute to particular and universal contexts. What were power‐laden structures of a ‘higher’ over a lesser state or quality in dominant metaphysical schemes and resultant structures are transformed in Process into lateral both/and fusions, a ‘cyclical movement of enfolding and refolding’, says Faber, without a set beginning or end (259). Whitehead further explains that ‘Any set of actual occasions is united by the mutual immanence of occasions, each in the other. To the extent that they are united they mutually constrain each other… thus the earlier will be immanent in the later according to the mode of efficient causality, and the later in the earlier according to the mode of anticipation’ (AI 197; emphasis added). In this mutual affectivity, the intensity and progress of each occasion depends, says Whitehead on the ‘enlargement’ of the physical data included rather than discarded toward an expansive potential (PR 349).

How might this event ontology that posits cycles of mutually immanent power, rather than a top‐down fixed structure, play out in clinical medicine? First, as we see in the above case study, the many‐sidedness of patients and families is not an intractable conflict to avoid, but the very conditions of care that must be engaged. The NP had to ‘Be Multiplicity’ as a contingent ‘who’ subjectively, procedurally, and perceptively engaging manifold dynamic factors.

At the bedside, the NP perceived (or prehends, per Whitehead) the complex ‘who’ of the deceased patient through the son's request that the incisions be sewn, through the hybrid influences driving that request across cultures and contexts. As bioethicist Leigh Turner writes in his work on medical pluralism, ‘In multicultural settings, patients and their families bring many different cultural models of morality, health, illness, healing, and kinship to clinical encounters’ that exceed universal aims of a ‘common sense’ morality (Turner 2003).

Within the healthcare structure, the NP also prehends the events of incoming nurses, the particular attending on duty (a different attending would have produced a different event), and the abstract frameworks of administration policy, economics, and law. Importantly, the case itself, as a unique procedural event, can and should contribute to the evolution of clinical and structural medicine as well, through a mutually immanent and affecting relational expansion of cross‐cultural care. In reflecting later on the Christian bioethical model that underpins her health system's covenantal approach of ‘whole person’ care, the NP remarked that ‘a covenant is between 2 parties, but in reality, the hospital has multiple competing parties. There are multiple “care” covenants, which are different for different arrangements… Some kind of pluralistic narrative or ethics would be more appropriate given these multiple lenses’.

A habitus of multiplicity necessitates a procedural engagement with plurality without relativism or a top‐down hierarchy. The Jain account of anekānta‐vāda, especially, describes an additive‐evaluative method of epistemic activity. The fact of infinite nayas, or dynamic perspectives on reality, must be actively sought out and coordinated together to get closer to complex reality or truth. As one scholar points out:

All the nayas… in their exclusively individual standpoints are absolutely faulty. If, however, they consider themselves as supplementary to each other, they are right in their viewpoints… [I]f all the nayas arrange themselves in a proper way and supplement each other, then alone they are worthy of being termed as ‘the whole truth’ or the right view in its entirety.

(Trapnell, qtd. in Vallely 2004, 110–111)

As a logical model, anekānta‐vāda is a ‘unique non‐hierarchical form of inclusivism because the superiority of Jainism [or any perspective] is established not by claiming that its knowledge is qualitatively better, but rather more complete’ (Barbato 2017, 124; emphasis added). Anekānta‐vāda offers a perceptive epistemic mode of keeping many positions in view and thereby enables the enlargement of one's own perspective, in this case, expanding the evolving scope of clinical and structural medicine. Rather than being a form of relativism, one's own positionality or experience is not abandoned or subordinated but enlarged through non‐hierarchical mutualities of perceptive becoming; one enacts a habitus of multiplicity to perceive more widely with and as a widening event.

As Jain studies anthropologist Anne Vallely clarifies, ‘many‐sidedness comes close to obligating its adherents to become familiar with other ways‐of‐knowing… toward the very core of pluralism, that is recognition of autonomy and legitimacy of the very diversity of human existence’ (Vallely 2004, 111). In the wider scope of Jain and Process metaphysics—that apply to the legitimacy of all dynamic existence, including the so‐called ‘nonhuman’—we glimpse the profound reach of a habitus of multiplicity for a more complete engagement with the life, or bio, of bioethics. ⁶ As the NP suggested, ‘Even though Christian bioethics can seem too stagnant or Western to address the “out of the box” nature of the multicultural dilemma I was faced with, the reality is that most nurses have already developed ways of comfortably engaging in competing covenantal arrangements, though we might not have a language or framework to discuss it with others’. She continues:

In a Christian (bioethical) lens, my agreement was entirely appropriate for whole person care, but instead, I felt others may not agree, so I looked for another religious lens that I'm not familiar with to justify an unexpected request. Maybe it's not that I felt any ‘moral distress’ at all, but that I just felt discomfort because ultimately I would have to address a person or group who has a different view than mine in what ‘care’ looks like? And somehow we have come to identify all conflicting ideas about ‘care’ as ethical dilemmas.

Cultivating a perceptive habitus of multiplicity requires expanding modes, terms, and frameworks to anticipate and solicit ongoing contributions to many‐sided models of care.

6. Case Resolution: Repositioning Ethical Dilemmas from Conflicts to Conditions of Care

After calling the Asian religions/philosophy professor, the NP informed the attending of her ‘religious’ justification for and agreement to the son's request to suture the incisions on his father's body. Although it was approximately 8 PM on a Friday, the attending still suggested the NP call the hospital's legal department for guidance on medically interacting with a body after death in an atypical manner. The NP opted not to call legal, believing she had provided sufficient justification for the decision in the patient records. She stayed after her shift to suture the holes herself and informed the family, who did not return to witness this process. The patient was sent to the morgue, cremated, and likely the family never saw the stitches.

Healthcare systems and hospitals are events, like reality itself, shaping and being shaped by other events. In the context of this dynamic multiplicity, a hospital is more akin to an organism or ecosystem than a container of space filled with inert providers, patients, or problems bumping around within it. This case study demonstrates that some ethical dilemmas reveal more about the stagnation of structures—and the resultant obstacles to expanding ontological, linguistic, and experiential limits within that structure—than they do any genuine moral problem. Fresh practices of expansion are needed that move from a habitus of inherited frameworks to a perceptive habitus of multiplicity.

The medical event of this case flared into becoming and was gone, like so many events in a progressive universe, but as Whitehead assures us, ‘that does not mean they are nothing’ (Whitehead 1967, 237). On the contrary, as medicine devises multiple means of curing, containing, and controlling recalcitrant bodies in routinized ways, the body—our own and that of others—remains a unique site of activity, as Chambliss writes, ‘to be approached with reverence or even with awe’ (Chambliss 1996, 25). He continues:

To the healthy person outside the hospital, the body is special, a thing distinct from other things in the world, and be treated as different… but for patients in a hospital, their bodies are dramatically profaned… often exposed to strangers… punctured by injection needles… the object of teachers' lectures to their students… touched frequently, often without special preliminaries. It is probed with fingers and hands and tools in ways that are sometimes brutal, with little respect for the body as a sacred object.

(25–26)

As a becoming occasion, or nexus, each body prehends and contributes data to the healthcare organism, preserving continuity and provoking change. Bodies of patients and providers are not merely passive objects, but reality‐producing events and perspective‐holding nayas, too often subordinated within frameworks of repetition and profanation, rather than welcomed as constitutive ‘many‐sided’ participants in the expansive event of care.

One need not be a specialist philosopher in Process or Jain metaphysics to practice their insights of life and knowledge. At its best, a ‘holistic’ or ‘whole person’ care model, including that of the faith‐based health system within which this case took place, already gestures beyond any simple top‐down objectification of nurses and patients toward an excess of dynamic life that exceeds existing structures. Still, the NP was forced to fit a novel request into a stagnant framework, rather than be empowered within that structure to cycle new requests and perspectives back into the organism's growth. Even as the NP recognised of the son's request, that ‘the question itself was a religious moment’—some kind of invitation into a reverent disturbance or sacred expansion—she was forced to appeal to an alternate ‘religion’ within a culture of justification that ultimately maintains the Western structure of ‘common morality’, self‐contained traditions, and a two‐party Judeo‐Christian covenant model.

Process and Jain metaphysics offer a perceptive mode, or a how, to prehend the multiplicity more widely in the clinical encounter and structural framework. To consider a clinical interaction with a body as a ‘sacred’ or ‘religious’ event, instigating reverence or awe does not mark it as the exclusive property of a single tradition or dogma. Rather, it recognises the body as a unique and world‐making opportunity site where cross‐cultural conflicts become the conditions of expansive care. Cultivating a habitus of multiplicity requires practices that: (1) anticipate the complex ‘who’ of each individual patient and provider as creative powers‐in‐process, (2) solicit novel inquiries between patients, providers, and health systems, including those previously ‘unheard of’ in dominant frameworks, and (3) promote procedural efforts to mutually pluralise, rather than relativise, non‐hierarchical care models.

Only through experimental modes of engaging many‐sided multiplicity can each becoming body—whether patient or provider—have ‘value for itself, for others, and for the whole. This characterises the meaning of actuality’ (Whitehead 1966, 111). Healthcare systems and structures must reposition ethical dilemmas, not as individualistic and abstract moral decisions to evaluate and contain, but as creative collisions promoting the perceptive growth of living care.

Conflicts of Interest

The author declares no conflicts of interest.

Donaldson, B. 2026. “Cultivating a ‘Habitus of Multiplicity’ in Cross‐Cultural Medicine: From Case Study Conflict to Many‐Sided Conditions of Care Through Process and Jain Metaphysics.” Nursing Philosophy 27: 1–9. 10.1111/nup.70065.

Data Availability Statement

Data sharing is not applicable to this article, as no datasets were generated or analysed during the current study