Close to the Bone: Social Constructions of Suffering and Dying

Tuesday, 23 July 2013: 11:25 AM

Anne Bruce, PhD, RN
School of Nursing, University of Victoria, Victoria, BC, Canada

Learning Objective 1: To contrast suffering and dying as taken-for-granted concepts within Canadian palliative care compared with Buddhist understandings and the impact for nurses working within pluralistic societies.

Learning Objective 2: To describe case study as a qualitative methodology along with its strengths and limitations for generating culturally sensitive knowledge and understanding for nursing.

Purpose: The social construction of suffering and dying are important concepts for understanding how health professionals determine what constitutes a good death. Such constructions can cut close to the bone and may support some patients and families while constraining those living outside of dominant social narratives. In this paper, Vajrayana Buddhist constructions of suffering and death are examined with a focus on the intersectionality of self, suffering, and non-attachment that challenge similar notions within current palliative care discourses.

Methods: A case study approach is used where palliative care nurses were concerned that a patient’s Buddhist beliefs were a significant factor in what they saw as inadequate pain management. In their opinion, the patient’s beliefs were responsible for her declining pain medication until she was in agony. 

Results: Discursive practices of what constitutes self (who dies?), suffering, impermanence, karma, and rebirth shape the relationship between palliative care practitioners and taken-for-granted notions of the aim of a peaceful death. Broadening understandings of a good death and taken-for-granted assumptions are needed in order to serve Buddhist patients and family at the end of life. At the same time, alternative constructions of what supports a good death also raise important questions and tensions when these understandings seem incompatible.

Conclusion: Contrasting social constructions of Canadian palliative care with Vajrayana Buddhist views sheds light on key questions faced by palliative care nurses: What are the limits of patient-centered care in the face of treatable suffering? At what point is the choice to suffer truly a patient’s choice? How do taken-for-granted assumptions of suffering and dying from any perspective hinder nurses’ capacity to serve? In this paper the socially constructed nature of suffering and dying are examined with an aspiration toward broader understanding of social and organizational processes shaping end-of-life care within pluralistic societies.