PURPOSE: To have more in-depth understanding of death acceptance among patients with terminal cancer in Thailand.
METHODS: A qualitative descriptive research approach was used to capture the perspectives of patients with terminal cancer about death acceptance. Purposive sampling was used to recruit the participants. A semi-structured interview guide was used during data collection to obtain in-depth interviews with 12 patients diagnosed with terminal cancer. An interpretive descriptive method was used for analyzing data. Analysis of the data for this study was conducted by the analytic team beginning at initial data collection.
RESULTS: The findings of this study revealed six major themes relating to death acceptance: 1) perceiving death as a natural part of life; 2) perceiving that death cannot be controlled; 3) thinking that death can come at any time; 4) letting everything go before dying: finding a calmness; 5) additional Buddhist practices: clean living and making merit; and 6) additional means for attaining a peaceful death and peaceful life before death.
CONCLUSION: Understanding death acceptance is important for nurses providing care for patients with terminal cancer in order to find strategies and support for patients to accept death and live peacefully with their family in the time they have left.
Presented here for analysis are distinct and opposed Buddhist perspectives on the issue of withdrawing life support from a brain-dead individual. Of the four views considered, Peter Harvey argues that withdrawal of care and cessation of treatment is justifiable in a Buddhist context. Another perspective (Scott Stonington and Pinit Ratanakul) points out that the Buddhist physician who withdraws a respirator acquires a karmic demerit that can negatively affect this life and future lives. This second view then concludes that Western bioethical resources are inadequate to address the problem of withdrawal of care. In light of these opposing ethical stances grounded in sectarian viewpoints, this presentation will argue that religious ethics should not be considered “irrational” due to their religious foundations. Furthermore, importing local religious concepts can be deemed morally justifiable if doing so endorses the “moral point of view” in its appeal to universalizability, impartial justice, beneficence, and adherence to a set of normative principles. Can ethics criticize religious views that do not conform to the moral point of view or that seem scientifically uninformed, irrational, sectarian, or in some cases even fanatical ? Even though Western concepts for bioethical analysis should not be accepted uncritically, appeal to the moral point of view is necessary for resolving moral problems even if specifics of that perspective may be backgrounded in non-Western contexts.
In the Western world including Canada, grievous and irredeemable health conditions, which cause unbearable suffering, has given support to the legalization of medical aid in dying (MAiD). It is unknown how Asian Buddhists who are in contact with the Western culture perceive MAiD. In this qualitative study, 16 Asian Buddhists living in Montreal took part in a semi-structured interview. Contrary to general findings in the literature, religious affiliation do not always determine moral stances and practical decisions when it comes to MAiD. Some participants were willing to take some freedom with the doctrine and based their approval of MAiD on the right to self-determination. Those who disapproved the use of MAiD perceived it as causing unnatural death, creating bad karma, and interfering with a conscious death. End-of-life (EoL) care providers have to remain sensitive to each patient's spiritual principles and beliefs to understand their needs and choices for EoL care.
BACKGROUND: Spiritual care is frequently cited as a key component of hospice care in Taiwanese healthcare and beyond. The aim of this research is to gauge physicians and nurses' self-reported perspectives and clinical practices on the roles of their professions in addressing spiritual care in an inpatient palliative care unit in a tertiary hospital with Buddhist origins.
METHODS: We performed semi-structured interviews with physicians and nurses working in hospice care over a year on their self-reported experiences in inpatient spiritual care. We utilized a directed approach to qualitative content analysis to identify themes emerging from interviews.
RESULTS: Most participants identified as neither spiritual nor religious. Themes in defining spiritual care, spiritual distress, and spiritual care challenges included understanding patient values and beliefs, fear of the afterlife and repercussions of poor family relationships, difficulties in communication, the patient's medical state, and a perceived lack of preparedness and time to deliver spiritual care.
CONCLUSIONS: Our study suggests that Taiwanese physicians and nurses overall find spiritual care difficult to define in practice and base perceptions and practices of spiritual care largely on patient's emotional and physical needs. Spiritual care is also burdened logistically by difficulties in navigating family and cultural dynamics, such as speaking openly about death. More research on spiritual care in Taiwan is needed to define the appropriate training, practice, and associated challenges in provision of spiritual care.
La première partie présente les sources de cette étude... La deuxième expose le système d'analyse des données. La troisième dresse une typologie des caractères finaux des noms bouddhistes donnés aux foetus et aux enfants de façon posthume, tandis que la quatrième analyse le type de ces termes finaux bouddhistes employés pour nommer les foetus et les enfants mort-nés. La cinquième partie explique les relations qu'entretient l'âge au décès avec les choix des caractères finaux des noms bouddhistes posthumes et la dernière partie présente les lois et réglementations qui régissent les enterrements.
Buddhist Chaplains chanting sutras after the Great East Japan Earthquake in 2011 often encountered survivors who felt that hearing sutra chanting itself ameliorated their bereavement grief. This research is the first experimental examination of the effects of sutra chanting on listeners' bereavement stress. Prior research demonstrates that sudden pet loss causes bereavement stress in students and that physiological stress can be noninvasively measured by salivary alpha-amylase. We asked Japanese college students to raise pet goldfish until they developed an attachment to them, then confiscated the fish, and told the students that they had to be killed. To compare the bereavement stress of groups listening and not listening to sutra chanting, we used psychological and salivary analyses. Perceived Stress Scale (PSS), Multidimensional Empathy Scale (MES), and State half of the State Trait Anxiety Inventory (STAI) psychological scales showed no statistically significant differences between sutra and control groups, but salivary analyses indicated measurable stress reduction in the sutra-listening group only. This pilot study tentatively confirmed the hypothesis that listening to Buddhist sutra chanting reduces Japanese bereavement stress. Further research is needed both to verify these stress-reduction effects and to determine whether such effects are primarily musical or cultural/spiritual.
Domestic Buddhist altars have long provided symbolically and materially rich media for venerating the dead in Japan. However, as Japanese household structures and funerary rites are unsettled in the contemporary era, Buddhist altars (butsudan) are rapidly being reinvented and digitalized. In this article, we describe the new technologies harnessed in butsudan production, the sensory experiences they offer, and their abilities to both reform and reinforce traditional networks of ancestral obligation. Despite promising death rituals that are more personal, secular, and affordable, the development of digitally enhanced material memorialization is still very much a work in progress in Japan.
AIM: The aim of our study was to investigate factors associated with burnout of nurses and care workers in nursing homes and geriatric hospitals in Japan. The use of Buddhist priests, the major religion in Japan, was also explored.
METHODS: Questionnaires for nurses and care workers were sent to 10 care facilities. The survey questions included basic demographic information, the Japanese Burnout Index and the Japanese version of the Frommelt Attitude Toward Care Of Dying Scale Form B. They also asked questions about use of Buddhist priests for tasks such as helping to manage the anxiety or distress of patients, families, and staff, or providing sutra chanting.
RESULTS: In total, 323 questionnaires were returned, of which 260 were used for analysis. Only 18 (6.9%) answered that they had any religious beliefs, which was relatively low compared to 27% from governmental survey data. In total, however, 71% expressed a need for Buddhist priests to help with anxiety or distress among patients. A positive attitude towards providing end-of-life care was a protective factor against depersonalization. It was, however, also related to lower feelings of personal accomplishment.
CONCLUSION: Care homes and geriatric hospitals may want to consider calling more on religious resources as a support for staff and patients.
Dans la vision bouddhiste, cette vie que nous vivons actuellement
n’est pas la seule ni la première que nous ayons vécue.
Quel que soit l’endroit où l’on naît dans ce qu’on appelle le samsara, l’on est exposé inévitablement à la souffrance. Nos vies commencent par la souffrance de la naissance et se terminent par la souffrance de la mort. Entre ces deux extrêmes se produisent quantité d’évènements générés par nos prédispositions karmiques. Le seul moyen d’échapper à la souffrance, c’est de se libérer du cycle des existences.
[Début de l'article]
OBJECTIVE: The objective of this study was to examine the religious/spiritual beliefs of followers of the five major world religions about frequently encountered medical situations at the end of life (EoL).
METHOD: This was a systematic review of observational studies on the religious aspects of commonly encountered EoL situations. The databases used for retrieving studies were: Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Observational studies, including surveys from healthcare providers or the general population, and case studies were included for review. Articles written from a purely theoretical or philosophical perspective were excluded.
RESULTS: Our search strategy generated 968 references, 40 of which were included for review, while 5 studies were added from reference lists. Whenever possible, we organized the results into five categories that would be clinically meaningful for palliative care practices at the EoL: advanced directives, euthanasia and physician-assisted suicide, physical requirements (artificial nutrition, hydration, and pain management), autopsy practices, and other EoL religious considerations. A wide degree of heterogeneity was observed within religions, depending on the country of origin, level of education, and degree of intrinsic religiosity.
SIGNIFICANCE OF RESULTS: Our review describes the religious practices pertaining to major EoL issues and explains the variations in EoL decision making by clinicians and patients based on their religious teachings and beliefs. Prospective studies with validated tools for religiosity should be performed in the future to assess the impact of religion on EoL care.
BACKGROUND: International guidance for advance care planning (ACP) supports the integration of spiritual and religious aspects of care within the planning process. Religious leaders' perspectives could improve how ACP programs respect patients' faith backgrounds. This study aimed to examine: (i) how religious leaders understand and consider ACP and its implications, including (ii) how religion affects followers' approaches to end-of-life care and ACP, and (iii) their implications for healthcare.
METHODS: Interview transcripts from a primary qualitative study conducted with religious leaders to inform an ACP website, ACPTalk, were used as data in this study. ACPTalk aims to assist health professionals conduct sensitive conversations with people from different religious backgrounds. A qualitative secondary analysis conducted on the interview transcripts focussed on religious leaders' statements related to this study's aims. Interview transcripts were thematically analysed using an inductive, comparative, and cyclical procedure informed by grounded theory.
RESULTS: Thirty-five religious leaders (26 male; mean 58.6-years-old), from eight Christian and six non-Christian (Jewish, Buddhist, Islamic, Hindu, Sikh, Bahá'í) backgrounds were included. Three themes emerged which focussed on: religious leaders' ACP understanding and experiences; explanations for religious followers' approaches towards end-of-life care; and health professionals' need to enquire about how religion matters. Most leaders had some understanding of ACP and, once fully comprehended, most held ACP in positive regard. Religious followers' preferences for end-of-life care reflected family and geographical origins, cultural traditions, personal attitudes, and religiosity and faith interpretations. Implications for healthcare included the importance of avoiding generalisations and openness to individualised and/ or standardised religious expressions of one's religion.
CONCLUSIONS: Knowledge of religious beliefs and values around death and dying could be useful in preparing health professionals for ACP with patients from different religions but equally important is avoidance of assumptions. Community-based initiatives, programs and faith settings are an avenue that could be used to increase awareness of ACP among religious followers' communities.
Point obscur de la réflexion et de la sensibilité contemporaines, la mort se tient pourtant à l'horizon de chaque existence humaine. Niée ou pas, il faudra bien qu'elle advienne... faudrait-il pour autant attendre le moment dernier pour y réfléchir ? De ce point de vue, les voies bouddhiste et chrétienne sont riches de toute une tradition réflexive, pratique et spirituelle. La mort n'y est pas taboue, bien au contraire : elle se présente dans toute son austérité ; dans toute sa capacité, aussi, à convoquer ce que chaque tradition porte en elle de plus important.
Réfléchir à la mort, c'est ainsi tenter une percée au coeur de chaque existence humaine tout autant que du christianisme et du bouddhisme en soi. Fruit d'un colloque présidé par Dennis Gira, théologien catholique et spécialiste reconnu du bouddhisme, le présent volume déroule son propos de manière pédagogique. Il part de considérations générales sur la mort pour envisager ensuite des aspects doctrinaux, éthiques, spirituels et liturgiques.
[Extrait résumé éditeur]
The delivery of spiritual care in Thailand is hampered by the absence of a model for health care providers that has contextual relevance within the country. Our aim is to develop a Buddhist Spiritual Care Model to guide health care providers in Thailand in the delivery of spiritual care practices for people at the end of life. The new Buddhist Spiritual Care Model builds upon the strength of existing Judeo-Christian theoretical models and extends those to a context where chaplains, for example, play no role in the care of hospital patients. To support Thai nurses in the delivery of Buddhist spiritual care, we have chosen to use 4 familiar steps from the nursing process (needs assessment, planning of actions, activities related to the plan, and effectiveness of activities). This is a thinking structure familiar enough to understand through which health care providers can be encouraged to begin to see themselves delivering spiritual care for people at the end of life and their family members. This theoretical model is conceptualized to allow health care providers to implement spiritual care within the normative environments in Thailand, regardless of their own spiritual affiliations and without relying on a specialist spiritual provider.
L'auteure teste l'hypothèse théorique selon laquelle des similitudes pouvaient exister entre l'expérience d'un mourant qui se défait de ses dernières attaches terrestres et celle d'un accompagnant qui s'efface totalement, dans une attitude proche de la méditation, pour accueillir pleinement celui qui meurt.
Cet article est le compte rendu d'une recherche exploratoire sur l'accompagnement spirituel des personnes en fin de vie à travers les pratiques dans quatre traditions religieuses ou philosophiques (catholique, musulmane, bouddhiste et laïque). Les résultats ont été présentés dans le cadre d'un certificat interuniversitaire européen en soins palliatifs entre les universités catholiques de Lille (France) et Louvain (Belgique).