Get all your news in one place.
100’s of premium titles.
One app.
Start reading
Bangkok Post
Bangkok Post
Comment

Prayer for the dying: will, morphine, peace

A harpist uses music to bring comfort to a dying patient in Oregon state of the US. In Thailand, there are very few hospices and hospitals to meet the increasing need for palliative care. (AP photo)

My parents were not only my role models in the way they lived their lives as fearless journalists and compassionate human beings, but in the way they passed -- quietly on their beds, in our family home, in the midst of the night, without any fuss, successfully avoiding frantic attempts to prolong their lives.

That is how I want to die, I told my daughter: In our home without life-prolonging tools, but with our garden view so I can hear the birds sing. And make sure that my beloved dogs are nearby.

I immediately realise I need a living will, and my daughter -- as much as I love her -- should not be the one to make such a final decision on my behalf. That would be my husband's job.

Sanitsuda Ekachai is former editorial pages editor, Bangkok Post.

"Are you crazy, Mom?" my only child protested, raising her voice in an attempt to stop the topic. "How can I let you go without doing anything. At least we have to try resuscitation."

Then she went on with some intelligible jargon from her medical training to convince me the decision should be left to medical experts.

Strange isn't it? Buddhism teaches mindfulness of death in order to live a meaningful life in the present moment. Yet death remains a taboo topic in Thai Buddhist culture; talking about it is considered a bad omen, a curse even, that precipitates death.

But as society rapidly ages, we "older persons" are fighting to preserve old cultural norms to let nature takes its course instead of being kept alive artificially.

When I joined a workshop on peaceful death organised by the Cheevamitr Social Enterprise last month, I just wanted to learn how to write my living will.

I came home realising that is the easiest part of my "peaceful death" project. The bigger challenge is having my mind be at peace when it's time to go. And making peace with my daughter about my last wish is a big part of that, too.

The law is on my side in making a living will. After years of debate, it is considered a legal document that must be respected. A letter of intent in our handwriting suffices. No witnesses are needed. We just have to make sure our family, or the person designated to make a decision about our end-of-life care, has signed copies to show the hospital.

But a peaceful death means much more than having a written will.

Of course, dying naturally helps prevent the unnecessary use of medical devices that increase the person's physical pain while plunging many families into bankruptcy. But there is no guarantee we will have it our own way.

Despite the living will, there may still be disagreement within the family.

Maybe our family members sincerely believe the latest medical technology can save us. Or in the case of an accident, doctors may put us through their emergency routines. However, it's not easy to take someone off a ventilator when they are on it.

Even when our family respects our wishes, the problems do not stop there.

A living will may take care of the legal aspect by guarding against a prolonged death, but the terminally ill still need to be taken care of physically and emotionally.

To have a peaceful death, the dying need to be free of the physical pain that accompanies their illness. Equally important, if not more so, is freeing them from any emotional knots -- to help them resolve past regrets and misunderstandings, to forgive, to be forgiven, or just to see someone one last time -- so they can pass peacefully.

What happens to our body when death nears also needs to be understood and treated properly to provide the dying with the most physical comfort.

For example, the dying need very little food and water -- if any at all -- in their last days. Insisting on feeding them only produces discomfort and other complications.

Death rattles are also natural and not as painful as we may believe. The use of a phlegm suction pump often causes great pain, preventing a peaceful death.

It's clear that end-of-life holistic care requires the use of specialists. They can advise relatives on proper care and administer the correct amount of morphine -- something which is now underused -- to maintain the patients' comfort level.

They also have the expertise and sensitivity to communicate with the dying person about their emotional needs, a skill their family members may lack.

The bad news is we have very few palliative care specialists in Thailand. There are also very few hospices and hospitals to meet the increasing need for palliative care as Thailand's population ages.

Taking care of the dying at home is also easier said than done. Even if they have willing relatives, a lack of access to morphine, which is illegal without a prescription, means torturous pain for terminally ill patients in their final days.

The use of ganja (marijuana), an effective pain medication, is also illegal in Thailand despite its long use as a home remedy before it was outlawed. The same holds true for kratom, another opioid that can relieve chronic pain.

As individuals, we can educate ourselves on how to treat the dying but we are still helpless as carers when effective pain medications are out of our reach.

We need a policy change at a national level. We need more hospices. We need to make holistic palliative care part of mainstream medical services. We need state support for better quality end-of-life care at home.

We need to amend the law so that marijuana can be used as a pain medication. We need to encourage doctors to use morphine, and make it more easily accessible for end-of-life care at home.

If not, a peaceful death is likely to remain in the hands of a fortunate few.

That aside, the use of morphine poses a problem for many Buddhists, who believe they need to retain a clear mind until their last breath to ensure "good rebirths".

Fact is only meditation masters or ace practitioners can transcend intense physical pain by themselves, says Prof Sawaeng Boonchalermwipas, a devout Buddhist and palliative care expert.

If you are not one of them, your last thoughts and feelings may well be overwhelmed by excruciating pain from your illness, particularly cancer. This is where morphine comes in, to maintain a state of calm and a peaceful last breath.

Spiritual care is a necessary part of end-of-life care. But Prof Sawaeng also cautioned against equating it with religious rites, rituals and prayers.

More often than not, peaceful music is better than taped sermons. So is being with loved ones. Best of all is fulfilling their unmet wishes or disentangling their emotional hang-ups, which works wonder to dispel fear and anxiety.

"Do what's best for the patient, not what you think's best," Prof Sawaeng says.

My living will is going to include a list of classical music, sounds from nature, and guided meditation of my choice, but with the full realisation that, despite my best efforts to stay in control, things may go awry. For who knows when our time will end, and how?

An important part of a peaceful death is to save relatives the guilt of feeling they did not do enough to help. Palliative care specialists can provide valuable intervention here. Still, it is best if we undertake this task ourselves.

My daughter may be in denial -- for now. But by raising the issue of my will, I hope we can resolve the details and reach an understanding -- and respect.

Still, the surest insurance policy for a good death is investing here and now in mindful words, actions and the practice of mindfulness.

At the end of the day, we have no one but ourselves -- with a little help from morphine perhaps -- to keep our body and mind at peace in our dying breaths.

Sign up to read this article
Read news from 100’s of titles, curated specifically for you.
Already a member? Sign in here
Related Stories
Top stories on inkl right now
One subscription that gives you access to news from hundreds of sites
Already a member? Sign in here
Our Picks
Fourteen days free
Download the app
One app. One membership.
100+ trusted global sources.