Bruce Arnold (University of Calgary) has conducted an ethnographic study into anticipatory dying in a Thai Buddhist hospice.⁷⁵

Arnold starts from the premise that although death and dying are feared and to be avoided, they also generate reverence, curiosity and mystery. So his interest was aroused when he came across a documentary about Thai schoolchildren visiting a Buddhist hospice in northern Thailand. In particular, he was struck by the sparse conditions of the hospice and apparent calm of the emaciated people as they anticipated their approaching death. Arnold writes:

‘As I watched the film I soon realised that these children were visiting the hospice as a school field trip to learn about Buddhist views of impermanence and value of life. They, without any awkwardness, talked with the dying about their lives and how they are experiencing the end of life. I was drawn to how bizarre this activity is within our cultural framing of dying, especially with the exposure of presumably innocent children to perhaps the most fearful of life’s experiences. Rather than being avoided, mortality and the associated suffering was being embraced as an important lesson for engaging life.’⁷⁶

The project was conceived by Arnold as a means of learning the end of life experiences from persons who appeared to approach mortality differently to those in his own culture. His study was based in a hospice facility in northern Thailand which cares for 300 people in the later stages of life, whose families could not look after them. Through a series of ethnographic interviews, he attempted to describe and explore his participants’ internal states as they ‘appear’ – an approach which is grounded in phenomenology. Given the nearness of death, he wished to ‘remain vigilant to the lack of reason, presence of spiritual reflection, emotion and non-linear aspects of the struggle for meaning as the participants faced the void of non-being.’ Consequently, each of his 30 interviews began with the same general question, ‘When you think about your own dying and death, what comes to mind?’

Alongside his analysis of the interviews, Arnold recounts his experiences as an embedded researcher. On one occasion, he is present when a person dies and comments:

It’s like nothing out of the ordinary has happened, and hospice activities continue. This woman is not covered but is left as she was with the exception of the head nurse closing her eyelids. The man on the next cot sits looking at her in silence and then turns on his side away from her and rests … I look around the hospice again and observe no change related to the death event, as if this is a routine event that warrants no special ritual. The normalcy of this event leaves me disoriented and numb for a while.⁷⁷

Reflecting on his encounters with members of the hospice community, and the meaning of what he has witnessed, Arnold notes the difference between the collectivist nature of Asian society as opposed to the individualism of the West – and he acknowledges the significance of cultural interdependence to end of life care. In this instance, Arnold was aware that Western presuppositions of the dualism between life and death were not embraced and in the hospice context, death was acknowledged as an integral part of life. He concludes:

All of the persons … appeared to approach the anticipation of death with compassion and tolerance as opposed to an anxiety projected into an unknowable future event. This is to a great extent the result of Thai culture and spirituality arising from the everyday metaphysic of Buddhism.⁷⁸