location: nan, 'Thailand 
year: 2003 source: HSRI 
title: The situation of death and dying paradigm shift 
abstract:The project is aimed to review health paradigm in which death and death management is considered.  The study is supposed to encourage society and relevant organization to review their concepts and pattern of death management, the current mainstream. Research should be supported in various dimensions, helping society to perform and confront with death effectively.  Invention, recommendation of various death management and congruent with Thai society, regarding of family, community context of patients and their relatives, are importantly included. ResultsThe study in patients and relatives, totally 12, data are collected form 10 relatives (after the death of patient) and 2 patients.  They mostly live in metropolitan area (Bangkok), and environ areas,  Only 30 percents live in outer area, supporting factors, and hindered factors, as follow:There is no integrity of thinking system.  There is a combined thinking system within society; there is still different way of thinking.  However, death concept is not always stable, it depends on the confronted situations.When facing with illness condition, there is a way of thinking like “when being ill, hospital treatment is needed”.  It is irrespective of social class, or economic status, They are all influenced by the same system of thinking.  The opportunity of accessible treatment may vary.  Therefore, tendency of hospital death increases.  In other words, the treatment gap of despair patient will be widened.For medical treatment procedures, it was found that there is communication gap between medical personnel and patients and their relatives, due to different way of thinking.  As a result, patients and relatives are lacks of treatment knowledge since their knowledge body is not the same as medical personnel, which brings about the limitation of accessible knowledge necessary to decision making for doctors and medical personnel.Opportunity provision for patients and relatives to participate in decision-making procedures during medical treatment is considered satisfyingly among medical personnel, patients, and their relatives.  A chance of knowledge accessibility is revealed, resulting in contracted gap, and furthers development in the system.Religious belief and ritual, family or community, and economic status are significantly considered as major factors lead to decision making of desirable death undesirable management.Home death could be both considered as good death and bad death; it depends on components of family, community, and social conditions.  Hospital death is not necessarily considered as bad death, if the medical personnel understand, interest.  Chance of displaying attitudes and potential of appropriate death management are revealed to patients and relatives, regarding of human’s pride respect.For revision of concepts, attitudes, patterns of death management, and medical system issues are included;  it was found that there are three core concepts as:Bio-medical model is focused on mechanism of physical performance.  Therefore, it should exclude death from ordinary life.Bio-psychosocial model is focused on mental and family dimension.  It is the concept that tries to reduce gap of Bio-medical model, providing opportunity to patients and relatives to participate in medical treatment procedures.  More medical standard are involved, for example, decreasing final pain and torture of the patients, counseling provision, and fact provision of treatment procedure, etc.  Those are all from palliative care, which provides convalesce residence for final stage patients.Spiritual model is viewed, as life is part of nature, Both are interconnected, Nothing is permanent, Death is natural.  Good health is just the only way to develop life more enrichingly, Death should not be avoided or managed, however, it should be reflected, This implies that death is not separated from life, Death objective is to release oneself from adhere belief.For basic information of organization working with final patient, including a case study of 15 initiative organizations, it was found that there are 50 percents of private organization working with HIV patients and final HIV patients.  The rest is in the early stage within medical schools, general hospitals, and community hospitals.  Mostly it came form patients’ problems in which they had to face with, and then the problems were gradually developed.  In addition, Catholic hospital is now focusing on patient governance, and treatment for final HIV patients is included.  From the interviews relevant issues were found as:Thai society has a certain resource of personnel and organizations pertaining to this area and develops a particular organization to help patients and relatives.  It is established in provincial areas, both public and private sectors.  It was unofficially merged by interested people, and circulated.Private organization of development is distinctive in terms of working closely with patients and relatives, more flexible, and neutral as a connector between medical personnel, and patients and relatives. For general hospital, especially for medical nurse faculty available, Catholic hospital is likely to pay more attention to final patients increasingly since there is academic research circulated among international academic stages.  At the same time, more mainstream acceptation of patient’ right is revealed.Community hospital should play an important role in supporting family and community to confront with death and death management effectively, through house visiting, Primary Care, and the convenience of patient transfer.The provision of hospital quality development system (HA) is responsible for clearer domain and more acceptation.  The relevant organization should employ the advantages to further or develop knowledge that can be actually practiced and congruent with local context of society.  The concept circulation and concept drive to relevant personnel should be included pervasively.RecommendationsThere should be deeper research and covered with various kinds of population.  Qualitative research should be focused since it can describe death into deeper dimension and it can access to human and spirit.  In addition, quantitative research can be used as result expansion and link of systematic change.Hospital quality development system (HA) is a critical channel to be forced into systematic change pertaining to treatment of final patient.  Therefore, practical research should be promoted as a pilot project in some hospitals whose interests are their primary bases.During data collection, learning opportunity is exchanged.  The organization network is linked both public and private sectors, which their interests and experiences relevant to final patient treatment are shown, it was found that most organizations have potential and readiness to develop newly trends of taking care and aiding final patients.  In addition, widely conditions of working are opened; the research institutes- public health system should grasp this advantage to develop knowledge body or to support the necessary and usable knowledge body collection.  Furthermore, patterns and various kinds of model should be broadcasted to the public as an alternative for patients and relatives.Documents pertaining to personnel, organizations, book, and research of death and other relevant documents should be made for anyone interested in to be accessed.