Life and the cultures of death

Coming to terms with the end can offer us a new beginning, as those who care for the terminally ill discover

Individualists see dying as a very personal matter. For others, the way in which we die can benefit those who survive us. It has been 14 years since the Venerable Buddhadasa Bhikkhu moved on to another realm, but his admirers continue to wonder at - and learn from - the way he faced his last moments in this world.
The monk suffered several strokes before lapsing into a coma on May 25, 1993. Forty-four days later he died at his residence in the forest temple of Suan Mokkh, having been released from hospital, still unconscious, on July 8.
It's been said that he would have died on his birthday, May 27, had his life not been artificially prolonged. While Buddhadasa lay in a coma, two cultures of dying clashed.
At a recent seminar commemorating what would have been Buddhadasa's 101st birthday, sociologist Prawase Wasi noted that the doctors insisted on using medical technology, while his disciples would have preferred to honour the monk's wish and let nature take its course.
"The monk said he would not carry his body to escape death," said Prof Dr Prawase, who visited Suan Mokkh in 1991, when Buddhadasa's memory was enfeebled but he could still occasionally preach.
Prawase recalled that he was studying abroad when his 85-year-old grandmother told a relative she knew her time had come to die, but she wanted to wait for his return.
Three months after he came home, his grandmother - though in good health - stopped eating and drinking and soon died peacefully.
It was a stark contrast to the view of death shared by many terminal ill people today, he said. Many are willing to spend a fortune trying to prolong their lives.
Prawase also frets over modern health treatment, remembering a woman who was devastated when hospital staff refused to let her hold her dying husband's hand.
Artificially prolonging life is widely viewed as the ethical way. Others see it as prolonging death.
"It's a very sensitive issue," Prawase said.
"We should be better able to understand the diversity of cultures."
Since Buddhadasa's death, Prawase said, more doctors and nurses have begun attaching greater importance to the dying patient's emotional state and try to ease their final moments.
Komatra Chuengsatiansup, director of the Ministry of Public Health's Society and Health Institute, cited examples of different cultures that utilise rituals to help people come to terms with death. China has a funeral tradition by which the relatives of the deceased cross a bridge seven times, symbolically accompanying the departed spirit into heaven.
In old Siam, said the Buddhist author and ecologist Venerable Paisal Visalo, death was acknowledged as a natural part of life with community gatherings. These days it's a private matter.
"Can you imagine what would happen today if you held a funeral in your housing estate?"
"These days," Phra Paisal said, "we try to forget death altogether. We search for physical happiness, glorify youthfulness and repel ageing."
Social worker Supaporn Pongpreuk found a way to integrate modern technology with dying peacefully at home. When she was diagnosed with breast cancer in 1992 she underwent chemotherapy, then decided to heal herself naturally, through meditation and mindfulness.
Her close friend Surapee Chootrakul saw the calming effect, and in a TV documentary taped six month before her death, Supaporn explained that she spoke to her pain "as a friend. 'Dear pain, today I have already tried - can you be kinder to me?'
"It depends on how you put your mind to responding to the pain."
Surapee joined Supaporn's relatives and other friends in taking turns visiting her at home, meditating with her, giving her massages.
One friend played the flute to soothe her - and became a better musician. Another helper learned how to help - he discovered the value of a caring community.
Dr Termseak Puengrasamee of Prince of Songkhla University, who treated Supaporn, said it was their mutual decision to pursue the self-healing at home.
Her home is where she really belonged, he said - she had elderly relatives there and a mae chee (nun) who Supaporn respected. They joined her meditation and chanting, which can't be done at a hospital.
Kandawsri Tulathumkij, a nurse in the radiology department at the same university, pointed out that groups of medical personnel meet regularly to share their experiences as caretakers of the dying.
"State-of-the-art technology alone can't help them die peacefully," she said. "The societal and spiritual approaches must come into play.
"Physical death is the same for everyone," Kandawsri added, "but when it comes to spiritual death, a hundred people have a hundred ways of dying."