In search of a ‘good death’ at home

By JINTANA PANYAARVUDH 
THE SUNDAY NATION

 

Chulalongkorn University students at a mini-exhibition about death displayed at a recent seminar held as part of the “Rest In Peace” research project led by Pavika Sriratanaban, wearing yellow, a sociology and anthropology lecturer at the university.

 

DEATH. Not many people want to talk about it ahead of time, perhaps viewing a discussion as bringing bad luck.

 

But at a recent seminar in Bangkok, participants embraced an open debate about whether patients should have the right to die naturally, and discussed how to encourage relatives of terminally ill patients to be more accepting of “palliative care” so that patients could spend their last moments with families rather than in hospitals.

 

With advances in medical technology, relatives have tended to ask doctors to prolong the life of patients in the last stage of illness, saying they were willing to pay for the cost. But health experts at the forum suggested that increased palliative care would help lessen patients’ pain and suffering as well as reduce the financial burden on country’s healthcare system.

 

 

Held as part of the “Rest In Peace” research project led by Pavika Sriratanaban, a sociology and anthropology lecturer at Chulalongkorn University, the seminar focused on suitable medical services for the last moments of people’s lives and on the proper role of palliative care in Thailand’s society and healthcare system.

 

Chanchai Sitthipan, deputy dean at the Faculty of Medicine at Chulalongkorn University, said he agreed with increasing the role of palliative care, as it stressed the patient’s quality of life rather than how to keep dying people alive at any cost.

“Patients who are ageing or chronically ill should spend most of their remaining time at home or in society rather than in hospitals,” the doctor said.

 

“‘Dying well’ is a death that minimises the pain and suffering. If a disease is incurable, we must know how to stop [medical treatment]. If we prolong the treatment, it will be a wrong use of resources,” he said.

 

He said all doctors wanted to treat patients until they got well, but the current healthcare structure and resources could not afford that in the case of patients who had terminal illnesses.

 

 

Chanchai said due to the shortage of medical staff and equipment it would put a huge burden on the healthcare system if relatives of terminally ill patients insisted on prolonging the lives of patients by having them kept to hospital instead of returning them home.

 

Wanna Jarusomboon and the Phutthika for Buddhism and Society network have campaigned for the right to die in peace for almost 20 years. Medical professionals in Thailand were professionally trained on how to save patients’ lives but not how to meet the needs of terminally ill patients, Wanna said.

 

So when faced with dying patients, professionals don’t know how to help them die peacefully, she said.

 

“We saw death as an enemy that must be conquered, but my network has campaigned for a new way of thinking. We don’t see [death] as a medical failure but instead aim to help patients have a ‘good death’,” she said.

 

Her network has campaigned for palliative care with the aim of raising awareness in society that death was just another part of life. She has seen an increase in people’s interests in end-stage care over the past decade.

 

Some of the dying end-stage patients Wanna has met wanted to die at home, but nobody was able to care for them there, she said.

 

That suggests that society must change its attitude towards the dying, said Wanna. She favoured a “compassionate community” model that encouraged people to build networks to help the people around them to die a good death.

 

“We should turn death from a burden into an opportunity for volunteers to help. We should not rely solely on healthcare personnel, otherwise the country might face bankruptcy [over medical costs],” she added. 

 

Clear policy

 

Thailand’s healthcare policy is now aimed at reducing illness and deaths but does not discuss how to ensure a good death, said Ukrit Milinthangkool, an adviser to the National Health Commission.

 

Moving toward a future with more palliative care was unavoidable, he said, and urged policymakers to issue clear policies and legal terms.

 

In fact, Ukrit said, it was the government’s duty to deal with this human rights issue by providing palliative care and related services for patients suffering terminal illness.

 

 

At the seminar, a question was raised about the definition of “the last home” to which end-stage patients would “return home [from hospital] and die”. Where is “the last home” in the context of a mobile society?

 

There was a consensus among the audience that they did not want the last days of their lives to be filled with loneliness and suffering and hooked up to intensive medical technology. On the contrary, for that final stage, most people preferred to be at peace, spending their final breaths in the embrace of their loved ones and then allowing their body to return to nature.

 

Three groups of Chulalongkorn students presented their research relevant to the topic of “Social mobility on cross-cultural deaths”, which studied the concepts of illness, dying and death prevalent among Myanmar people, Indians and Japanese people living in Thailand.

 

The first group conducted the research on Myanmar workers in Khao Yoi district, Phetchaburi province, and found that in Myanmar society, death was a taboo topic of discussion because the time had yet to come. But the Myanmar workers agreed that if they died they would want it to be in their motherland and surrounded by their families and friends.

 

The second group studied Japanese people living in Chiang Mai where around 2,000 long-stay Japanese reside. They found that Japanese society was wide open to discussing death, as they believed that nobody could avoid this reality of life. 

 

The Japanese tended to be well-prepared for their deaths, the students learned. For example, they would write a letter to say “au revoir” before breathing their last. The Japanese were willing to die if they thought they could no longer make a contribution to the lives of other people. 

 

Their last home could be anywhere, but they wanted to be surrounded by their families.

 

In studying the Indian people living in Thailand, the student researchers learned that they were not afraid of death, as it was one of their goals for living. “Death cannot be avoided. It’s just a transitional path to a new territory, so there is no need to grieve,” said the group in summing up what they learned from talking to staff members at Wat Witsanu Hindu Temple in Yannawa district, which is the centre of the Hindu community in Bangkok.

 

Indian people wish to die in the embrace of their family or at a hospital because it is a more convenient way to handle the funeral, the students said.

 

Source: http://www.nationmultimedia.com/detail/national/30346866

 

 

-- © Copyright The Nation 2018-06-03

the best thing they can do is to promote legal nembutal

to those who wish to die without further pain

36 minutes ago, rooster59 said:

viewing a discussion as bringing bad luck.

Luck, the crutch of the unwilling , the non-thinking

This is an interesting philosophical topic for a Sunday morning, and one that societies around the world will have to face given the ever-increasing cost of providing health care.

 

I think the economic argument of deciding to end treatment is overwhelming; when it is clear that death is coming, it is hard to argue that tremendous resources should be spent on that person. That said, I look at the American example where private companies fund insurance and shudder at the thought of profit-making entities deciding things like that; better a society make a few hard decisions rather than a for-profit corporation. And, I shudder further if the sole basis of those decisions is purely economics; it is FAR too easy to see what would happen to the poor as opposed to the wealthy...

 

"...Chanchai Sitthipan, deputy dean at the Faculty of Medicine at Chulalongkorn University, said he agreed with increasing the role of palliative care, as it stressed the patient’s quality of life rather than how to keep dying people alive at any cost..."

 

Increased palliative care is likely a very good thing, as well as an increase in hospices. Simply put, would you rather go at home with family or at a hospice surrounded by good people, or at a hospital with tubes sticking out of every orifice?

 

It is an easy decision for me...

 

I was not consulted about being brought life. As sure as hell I will institute my departure. Make assisted suicide legal here.

Everyone has time.

And time to go.

Not fear.

19 minutes ago, Anak Nakal said:

Everyone has time.

And time to go.

Not fear.

I think the fear is not about going but in what way.. long and suffering or an assisted way out. 

Falling from tall buildings sometimes involuntary seams  to be the favoured way out and cheaper.

2 minutes ago, sammieuk1 said:

Falling from tall buildings sometimes involuntary seams  to be the favoured way out and cheaper.

Death is very often not instantaneous and not a recommended way to go. 

1 hour ago, sammieuk1 said:

Falling from tall buildings sometimes involuntary seams  to be the favoured way out and cheaper.

not favored, just not given options,

give whomever wants nembutal i say, a good death as oppose to the

very graphical squashed in concrete

5 hours ago, Samui Bodoh said:

This is an interesting philosophical topic for a Sunday morning, and one that societies around the world will have to face given the ever-increasing cost of providing health care.

 

I think the economic argument of deciding to end treatment is overwhelming; when it is clear that death is coming, it is hard to argue that tremendous resources should be spent on that person. That said, I look at the American example where private companies fund insurance and shudder at the thought of profit-making entities deciding things like that; better a society make a few hard decisions rather than a for-profit corporation. And, I shudder further if the sole basis of those decisions is purely economics; it is FAR too easy to see what would happen to the poor as opposed to the wealthy...

 

"...Chanchai Sitthipan, deputy dean at the Faculty of Medicine at Chulalongkorn University, said he agreed with increasing the role of palliative care, as it stressed the patient’s quality of life rather than how to keep dying people alive at any cost..."

 

Increased palliative care is likely a very good thing, as well as an increase in hospices. Simply put, would you rather go at home with family or at a hospice surrounded by good people, or at a hospital with tubes sticking out of every orifice?

 

It is an easy decision for me...

 

Hard to disagree, but first there must be a vast improvement in the standard of palliative care available for those terminally ill hospital patients who elect, or who are persuaded, to die at home.

 

My stepson's young wife had terminal stomach cancer and was in terrible, chronic pain. The local hospital sent her home to die - which she did within a few weeks - with just paracetamol. 

 

Marijuana is well known for its theraputic qualities, which include reducing pain and other common symptoms of cancer. Perhaps its legalisation should be considered not just for the benefit of the islanders of Phuket but for the rest of us. After all, half of us can expect to get cancer at some time in our lives.

4 hours ago, brommers said:

I was not consulted about being brought life. As sure as hell I will institute my departure. Make assisted suicide legal here.

you only have to jump

lots of people seem to do it

3 minutes ago, AGareth2 said:

you only have to jump

lots of people seem to do it

Too messy and soul destroying for friends/rels, and those who witness it or who have to clean up the mess.

 

A small container of helium, a pipe and a plastic bag with a draw-cord (or similar) and a peaceful, non messy departure should ensue.

 

That's my plan anyway.

I am suitably impressed that the Thai Universities are even discussing the subject.

 

2 hours ago, xylophone said:

Too messy and soul destroying for friends/rels, and those who witness it or who have to clean up the mess.

 

A small container of helium, a pipe and a plastic bag with a draw-cord (or similar) and a peaceful, non messy departure should ensue.

 

That's my plan anyway.

A lethal dose of a strong opiate is what I have selected 

But only after enjoying one last bottle of fine Irish whisky and securely in a location I won't be disturbed

The worst thing I can imagine is waking up in hospital after being "saved" by some do gooder

 

People considering jumping off balconys should think again because not everyone dies and you may wake up in hospital in more pain than you've every imagined

18 minutes ago, Ks45672 said:

A lethal dose of a strong opiate is what I have selected 

But only after enjoying one last bottle of fine Irish whisky and securely in a location I won't be disturbed

The worst thing I can imagine is waking up in hospital after being "saved" by some do gooder

 

People considering jumping off balconys should think again because not everyone dies and you may wake up in hospital in more pain than you've every imagined

I have been part of emergency team bringing drug addicts back to life, and I can tell you after the adrenalin injection, some where not happy at all, and we would meet them soon again for another ride. 

28 minutes ago, Hummin said:

I have been part of emergency team bringing drug addicts back to life, and I can tell you after the adrenalin injection, some where not happy at all, and we would meet them soon again for another ride. 

I know several people who were heroin addicts in Europe and they were "saved". A few times by ambulance and hospital staff when found passed out in public places

 

Usually they are angry because after they get a shot of naloxone they wake up with withdrawl symptoms immediately and need more heroin which obviously isn't an option

why are the teenagers with braces and smiles,standing around the pie charts??  

15 hours ago, rooster59 said:

That suggests that society must change its attitude towards the dying, said Wanna. She favoured a “compassionate community” model that encouraged people to build networks to help the people around them to die a good death.

It's not necessarily 'society' as much as it's a government which stigmatizes and makes illegal the very palliative substances that will allow end-stage patients not to suffer the dying process at home.
Can you be prescribed morphine for use at home - No.
Can you have marijuana at home without risking being thrown in jail - No.

So it is those in so-called leadership positions who keep the average citizen from obtaining adequate palliative care. 
"But, but, it's reflective of society."
Ok, so be leaders and lead your country into the 21st Century!  In the West we treat our pets with more dignity and compassion than can be found in Thailand for human end-of-life patients.  I don't believe that there are hospices in this amazingly backward country.  Perhaps mats on the floor of a temple somewhere where the dying are allow to expire in agony.  But a real hospice with staffed equipped to administer palliative and end-of-life counseling and care?
For a nation that prides itself on it's Buddhism, the vast majority show a complete lack of compassion and empathy for the suffering of their fellow man.  The tools to end physical suffering medically are available if they are legalized and promoted instead of stigmatized and reviled.

Kudos to the students and staff at Chulalongkorn University who have the compassion to bring this issue to the light of day.

Edited June 3, 20188 yr by connda

1 hour ago, connda said:

Kudos to the students and staff at Chulalongkorn University who have the compassion to bring this issue to the light of day.

Agree totally. This is an issue that needs to be discussed.

There is nothing beautiful or clamorous about death.

 

I can remember witnessing several of my elderly family members becoming chronically ill and dying slow deaths. My paternal grandmother suffered and lingered on for 4 years after she became bed ridden and almost like a vegetable after she suffered a stroke at age 90. Seeing my grandmother being taken care of by family members, spoon fed, washed and having her backside wiped by her daughter was totally undignified for my grandmother. Eventually when death came for her, she weighed just over 25 kilos and it was a relief for all of us and my grandmother to see her long suffering ended.

 

A good and dignified death for the chronically ill with no hope of recovery is voluntary Euthanasia. People should be given the right to die as a human right rather than being imposed to endure long pain and suffering by law. 

5 hours ago, mok199 said:

why are the teenagers with braces and smiles,standing around the pie charts??  

Maybe they are students at the university conducting the study.

6 hours ago, mok199 said:

why are the teenagers with braces and smiles,standing around the pie charts??