AbstractThere is growing interest globally in the way care is delivered to people at the end of life. Every context has its own complexities regarding the provision of appropriate care to patients at this point. However, what constitutes a ‘good death’ and how end-of-life care is provided to dying patients is culture specific. Although there is no formal definition of a good death, in general it refers to culturally prescribed ways of providing care so that a patient can die peacefully. Despite various notions of a good death existing in different cultures and contexts, western ideas of patient autonomy, choice and agency appear to be privileged as key components in institutional palliative care practice around the world.
This thesis examines the perceptions, practices and experiences of a good death in a palliative care setting in Bangladesh and compares and contrasts these to the notions of good death in western settings. The objectives of the study are: to understand the notions of a good death among healthcare providers, dying patients and their family caregivers in a Bangladeshi context; to understand how these stakeholders negotiate the idea of a good death; and how current palliative care practices work to ensure a good death. The study uses data from 30 in-depth interviews and from ethnographic observation of palliative care practices in the Centre for Palliative Care (CPC) and its two community-based projects in Dhaka, Bangladesh. The key findings of the study are: first, despite there being four components of total care (physical, mental, psychological, and spiritual) in western settings, the providers in this study conceptualise these as only two categories: physical care, and non-physical care. Although physical care is hampered by the opioid unavailability, a good death is still provided through non-physical care, in which a family-like relationship is built between patients and providers. Second, despite providers anticipating that patients will achieve open awareness of dying in their final days to ensure their ‘good death’, patients’ awareness of dying is experienced differently through the intervention of their family members. Third, rather than the importance of patient autonomy, choice, and agency found in western palliative care settings, more family-centric notions are revealed through mutual obligations, relational autonomy and interdependence between the patients and family caregivers in this study. The thesis concludes that despite there being some common end-of-life care practices worldwide, different understandings of end-of-life care exist in Bangladesh, which contribute to how plural end-of-life care futures can be understood.
|Date of Award
|Karen Lowton (Supervisor) & Shahaduz Zaman (Supervisor)