Compassionate Communities for Dignity in Death

Most respond with intimations of a ‘good death’ when asked to describe their ideal manner of passing, but how many of us have actually taken the matter under serious consideration? Most of us tend to invest our time and resources into “living well”, while only a small minority carefully prepare themselves, in body and in spirit, for a good death. The disparity can be explained, in part, by the fact that many of us see death as a distant matter, though the truth is that death is always close by. For we can die at any moment, with no certainty of living to see tomorrow.

Given this general attitude towards death, it comes as no surprise that Thai society of today demonstrates little interest in developing the social structures that will help people “die well”. In fact, the responsibility of providing for a good death falls on individuals and families, who struggle to make the necessary arrangements on their own, and often only become aware of the issue once someone close to them becomes gravely ill or is near death. As a result, many people spend the last moments of their lives in pain and suffering as they neglect, or do not have the time, to properly prepare, and thus lack the necessary conditions for dying well. Not only that, family and friends also suffer to see their loved ones in pain, mourning their passing with sadness, anguish and guilt at having to see someone dear to them die in distress. 

Cultivating the conditions for a “good death” is possible, but a perspective and skillset that centers the emotional well-being of the patient is crucial, on top of a profound understanding of life that sees death as perfectly ordinary. Of course, what can’t be overlooked is the physical comfort of the patient, that they are not preoccupied by pain, rather than resorting to measures that aggravate their physical suffering (which can often be a consequence of medical technology developed for the sole objective of prolonging a patient’s life, regardless of the cost to the patient’s overall well-being).

For a family to gather and mobilize the necessary knowledge, technology, equipment, environment and personnel to provide a “good death” for a loved one is a near impossible task. Many rely on networks of friends and relatives for help, and receive limited support from healthcare workers, who are often already stretched thin by work. With the help of such coalitions of support, many patients have been able to depart from this world peacefully.

Nonetheless, there are still a number of families unable to provide their loved ones with a peaceful death, not least because they are unable to access the resources listed above (not to mention many others who prioritize the prolongation of their loved one’s life over comfort and overall well-being). Even more troubling is that the number of families struggling to support dying loved ones grows by the day. As Thailand transitions into an aging society, the population of critically and terminally-ill elderly increases, while the sector of those able to care for them — children, younger family members, an already insufficient sector of healthcare workers dedicated to end of life care — shrinks.

Families struggling to provide end of life care for their loved ones should not be neglected. Thai society has the capacity to provide end of life support for all but for this to happen, the provision of care should shift from the responsibility of individual families to expanded networks of compassionate community members that work to address each family’s needs. For example:

  1. Volunteer networks that advise on and share caretaking responsibilities, such as spending time with patients or taking them out for a change of air, allowing primary caretakers time to physically and emotionally recharge. Volunteers who are unable to directly care for patients can help in other ways. Doing the housework for patients without family support or caretakers who are themselves sick or elderly can be an invaluable help, as the various demands of sickness and caretaking can make maintaining a clean and suitable living space a challenge.
  2. Networks for the distribution of equipment for end-of-life care can operate as a base for donations and redistribution. There are many people who wish to provide aid — whether that be brand-new equipment from generous donors or second-hand hospital beds and oxygen tanks — but there has yet to be a centralized network for donations and aid.
  3. Support systems for palliative care workers can provide mental health support, training and counselling for overextended and exhausted healthcare workers, especially nurses, who accrue physical and emotional fatigue.
  4. Palliative care systems can act as intermediaries between patients, family members and the healthcare system and provide education on palliative care to family members. In the long term, these networks should also work towards expanding the capacity of the Thai healthcare system to care for terminally-ill patients.

These networks are communities bound through a common spirit of generosity, born of the desire to help people in need, which nowadays are not only the homeless, hungry, disabled and elderly, but also terminally-ill patients and their families, whose hardships multiply by the day. Since the size of the average family has grown smaller, a family may have only one or two members able to provide care for patients, whereas before, families consisted of extensive networks of relatives and numerous children. In rural areas, an entire village can share familial ties, and mobilize in support of one another. This community presence is an important component of a “peaceful death”, despite rural communities lacking access to advanced medical technology.

Compassionate can go a long way towards alleviating the struggles of poor people. If we make their material and spiritual welfare our goal, we realize that true compassion is not made manifest by good intentions — the desire for them to transcend hardship — alone. Organising and building relationships in groups and communities, and the effective distribution of resources, are also important elements of practicing compassion in a way that creates the change we want to see. 

Generosity and compassion towards those who are underprivileged have always been part of Thai society. If we, guided by our sense of solidarity, gather and build networks that have the capacity to materialize our will into material support for poor people, we will see our efforts grow and flourish. Cultivating these networks so that they extend across the country will strengthen the spirit of generosity that resides in our society, such that it permeates the hearts of people and our healthcare system. It is then that compassion will become a cultural force of great power in our society. 

About the Author:
Phra Paisal Visalo is the abbot of Wat Pa Sukato and the president of the Buddhika Network Foundation for Buddhism and Society