This paper reports the constructions of karma by four Thai family caregivers living with a dying person with AIDS in Southern Thailand. These four families form a subset of a larger ethnographic case study exploring the experiences of families living with a relative with AIDS. Serial interviews, observations, and field journal were used as data collection methods with the four families. The findings indicated that the karmic quest is a dominant theme in the narratives of these families caring for their loved ones dying with AIDS. The 'calm and peaceful' death that is described in the palliative care literature equated with their desire for the Buddhist philosophy of a harmonious death. The families used the law of karma and reincarnation as their mainframe of reference and mobilised their religious resources to create meaning and purpose. Karmic healing activities were aimed at ending suffering, promoting a peaceful and calm death and ensuring a better life in the next one. The findings are important for the development of palliative nursing practice in Thailand by acknowledging religious and cultural values to promote peaceful death.
karma; spiritual; AIDS; Thailand
Received 1 December 2006 Accepted 29 October 2007
Issues related to spiritual distress and spirituality among people with HIV/AIDS are common, as AIDS threatens the integrity of not only the patients but also their families. A diagnosis of AIDS often leads persons to a quest for meaning in their experience (Dunbar et al. 1998; Peri 1995; Carlisle 2000). Feelings of anger, loss, uncertainty, vulnerability, guilt, shame, despair and hopelessness are common experiences in living with AIDS (Alexander 1994; Flakerud and Lee 2001; Kylma et al. 2001; Lippmann et al. 1993; Prachakul and Grant 2003; Reynolds and Alonzo 1998; Stajduhar and Davies 1998; Hall 2001 jMizota et al. 2006).
In Thailand, a large proportion of the population has been affected by AIDS, either directly or indirectly, since the first case was reported in 1984. It was estimated that in 2005 the cumulative number of people with HIV were about 1,092,327, and 508,300 people with HIV/AIDS required health care services (Department of Epidemiology Ministry of Public Health 2005). The majority of people have little or no access to treatment; as a consequence, AIDS remains a fatal disease for most Thai people, and sufferers are often cared for by their own families at home (Chadbunchachai et al. 2000; Songwathana 1997; Songwatthana et al. 2001 ; Yachompoo 2001).
As 94.5% of the population in Thailand is Buddhist, the Buddhist doctrine has framed conceptions of life, suffering and death in Thai society. Although Philosophical Buddhism constructs the doctrine of Karma (or kamma in Pali), this sophisticated form is highly abstract and difficult to understand and practice. At the popular level, the term 'karma' is transformed to 'bad luck as punishment for previously committed sin' (Buddhadasa Bhikkhu 1999: 41). In everyday life, Thai Buddhists use the law of karma to interpret their present existence, particularly their social status, as the result of an accumulation of merit (bun) and demerit (baab). Wealthy and healthy people are viewed as having been meritorious or morally good, and can enjoy spending their fund of merit accumulated from their previous lives. In contrast, the poor and the sick are suffering because they had not accumulated enough good merit in their past lives. As merit and demerit is the central popular concern (Sweaer 1995), most Thai Buddhists perform merit making with the belief that it will improve their meritorious status and secure a successful reincarnation (Tambiah 1970).
This paper reports the constructions of karma by four Thai family caregivers living with a dying person with AIDS in Southern Thailand. These four families form a subset of a larger ethnographic case study exploring the experiences of families living with a relative with AIDS. …