The ability of critical illness to disrupt our ideas about human life and relations has been the object of much attention in the humanities and in anthropology. In this talk, I describe the appearance of the cancer epidemic as such a disruption in a moment of transformation in the political economy of India. Drawing upon ethnographic fieldwork from 2011-12 in the Indian public health world, I examine a world of doubt, where the unsettling effects of cancer are exacerbated by the collapse of the Indian welfare state’s responsibilities to the poor. In this space of doubt, I show how the emergent medical specialty of palliative care exceeds its mandate to manage pain, seeking also to maintain the humanity of the poor that are now increasingly excluded from treatment. More broadly, I describe palliative care as illustrative of a new form of global humanitarian work, where an old impetus to preserve human life grapples with the new moral paradox of helping the poor die with dignity.