Health and environmental sciences; Social sciences; Bioethics; Buddhadasa; Death and dying; Dying; Palliative care; Thailand
摘要
In Thailand, a series of global and local political events has destabilized the concept of dying and begun to replace it with a competing concept known as “the end of life.” As a result, the ethical frameworks governing the Thai deathbed have become disjointed. This dissertation is about the origin of these frameworks and how individuals, families and care providers navigate them. In Northern Thailand, dying has traditionally been conceived in two phases. First, from diagnosis until the hours before death, family members are driven by an imperative to pay back a “debt of life” to their relative by giving them “heart power” – support based on a unique model of the relationship between heart/mind, body and social world. The imperative to give “heart power” sets up an ambiguous relationship to truth-telling, which can drain heart power and hasten death. Second, the last hours of life are governed by an imperative to optimize the separation of body and spirit at the moment of death, best achieved in the familiarity of home rather than the metaphysically polluted hospital. It is into this ethical environment of these two phases that the new object “end of life” has arrived. In the 1990s, a military massacre of pro-democracy protesters and a scandal in the Buddhist clergy caused an opening in the traditional structures of Thai power. During this opening, the famous activist monk Buddhadasa died in the intensive care unit, against his wish for a natural death. Political and religious reform groups rallied around the Saint’s death as the focus of their interventions for Thai society. They proposed a set of new ethical figures: the figure of the dying patient as a rights-wielding citizen, and the figure of the dying patient as seeker of wisdom. These ethical figures require a knowing subject and stretch the moment of death into a prolonged “end of life” that can be used for subject formation. These figures clash with the existing frameworks at the deathbed, which require an ignorant subject and conceive death as a moment. Individuals must navigate among these politicized ethical frameworks to make decisions about dying.
