Thaipreecha, L., Bunchua, K. & Harimtepathip, M. (2019). The Caring of Terminal Stage Patient According to Postmodern Philosophy. In Proceeding of the National and International Academic Conference and Research Presentation, Suan Sunandha Rajabhat University 2019 (pp. 81-88). Bangkok: Suan Sunandha Rajabhat University.

Abstract
The objective this philosophical research was to answer the philosophical question: “Could Postmodern philosophy apply to serve the terminal stage patient”. The result is found out that the opposite side had the reason: “The caring of palliative patient must be served with modernist philosophy solely”, because only the scientific procedure has credibility and universality. But the researchers’ opinion was contrary to such an interpretation seeing that it had weaknesses that could be disputed. The conclusion of that interpretation ignored the ethic of caring which is the essence of the postmodern philosophy, especially in terms of creativity power that is the new medical technology and the innovation advance so quickly because of creativity which thinks outside the traditional scientific limit. When the modern philosophy dominates, it often block the creativity. Whereas strengthening the critical thinking of the patients, including the application of
creativity, adaptivity, collaborativity and requisitivity, to reach the highest ideals in life, it results in a betterment of the quality of life and the patients would accept the illness happily.

Key Words: Care / Terminal Stage Patient / Postmodern Philosophy

Introduction
Illness is a problem that every man must confront. The treatment of illness today with modern technology and medical innovation enhance the patients’ hope of cure, recovering from disease and longevity. However, the many of sick especially the terminal stage patients, understand that they are treated with compulsory treatment or are forced to choose just the treatment available. Therefore, the present patients may be divided into 2 groups, one group expect to be cured from the disease because they believe in the up-to date treatment process. Another group fears death due to the medical technology that can identify the stage of the disease and predict the remaining time to the end of life.

Both high expectation and panic cause some patients to suffer physically and mentally, then some of the patients choose to escape suffering by deciding to end their lives (the right to die with dignity). On the other hand, there are too many patients who understand the symptom of their disease and still live happily with the disease and give the remaining time to find the reality of life. They were seeking ways to take care and develop their health, resulting in the treatment of the illness stepping up in a better outcome. The self-caring and development of patients is a virtue that can bring authentic happiness to life by the act of the intellectual instinct of man called that “intellect-know- itself” process (Bunchua, 2016) counting that this group of patients truly knows their own identity, as Socrates taught: “Know Thyself” (Bunchua, 2003, 120-122)

The patients, who understand the cause and reason of their sickness, will reach the realities of life, be interested in learning and seek information related to palliative care and self-development. The stage of critical mind would be empowered by having information from the sound sources and 4 postmodern forces (creativity, adaptivity, collaborativity and requisitivity) together with the 3-Dare principle which were daring to accept the illness, daring to evaluate their behavior that affects symptoms and daring to change health habits or accept the consequences with responsibility. The detachment was implied to their own beliefs and leveling the cooperation with the medical personnel in the treatment process, rehabilitation and preventing from recurrence. All of these principles and practices are recommended by moderate postmodern philosophy, which focuses on improving the quality of life and believing that the pursuit of happiness of each person will lead to happiness in both aspects: physical happiness and mental happiness, which depend upon the beliefs, worldview, ways of thinking, and paradigm (Bunchua, 2014, p.4), including the satisfaction of life by the fulfilling their needs, according to Maslow’s Hierarchy of Needs Pyramid (DePoy & Gilson, 2012, pp.121-122, referred in Harimtepathip, 2017).

In addition, it advisable to encourage caregivers to be happy to take care of patients by doing the ethic of caring, which is “seeking happiness on the happiness of others” (Bunchua, 2008, p.198) and having volunteer spirit to promote the patients’ good health and apply holistic healthcare principles to the therapy process for developing balance in human elements in 4 domains, namely physical, psychological, social and spiritual domain (Rungnei, 2016, Sakloetsakun, 2006) in line with the healthcare policy and medical-patient
engagement approach. The policy support the people to have the ability to manage their own health, the community to manage their own community and to adjust the attitude to health management that should not focus only the money but should be considered in terms of providing welfare from the state (Sangkanchanawanich and Suwanbundit, 2016).

Moreover the moderate postmodern philosophy believes that the provision of medical services are treated in the philosophy of value (axiology), is one of of the sub branches of Aesthetics, which is the study about the sense perception, belief, liking, favoring, faith and their meaning in life, living, and thinking that have the base on the intellect instinct. Patients even being sick, they still can have authentic happiness. If the illness does not cause abnormalities in the nervous system and disability of organ, the patients will surely are able to reach the aesthetic wisdom which is the value of goodness that responds to the mind according to his own potentiality (Takaew, 2014). Human beings can have true happiness only when the mind is exposed to the highest value, such as the truth, the goodness and the beauty, good deeds, benevolence, sacrifice, practice the of faith. If medical personnel and patient relatives deploy this approach in congruence with disease treatment, it would surely drive the power of the patients to seek something to improve their quality of life and get the authentic happiness according to reality.

In conclusion, the moderate postmodern philosophy, the modified Maslow’s
hierarchy of needs theory, the ethic of caring and the holistic healthcare including the people-medical engagement approach, are important in promoting the value and dignity of the patients, supporting the patient to be in the stage of goodness in life and able to accept their illness happily. The researchers had interest in the philosophical study on the terminal stage patient care according to the moderate postmodern philosophy by analysis, appreciation and application for the development of the quality of life of the patients.

Objective
To answer the philosophical question: “Could Postmodern Philosophy apply to serve the terminal stage patients?”

Scope of research

1. The researchers set up a framework for research the care of the terminal stage patient concepts and the hermeneutics with philosophical paradigm.
2. Research duration
   Duration of 12 months from January 2018-December 2018

Research Methodology

1. Research method
   This research is a qualitative research to study the philosophical paradigm on caring of terminal stage patient.
2. Research process
   This research was held on two philosophical processes: dialectical and discursive. Dialectical method is to ask question that may answer pluralistically. Discursive method is to exchange ideas by demonstrating the reasons that support each answer to find the best answer from compromising all parties as possible with reasons.

Review Literature

1. Terminal stage patient means patients with symptoms of various diseases and the doctor had no plan to treat the disease anymore, and only palliative treatment is done.
2. Medical procedures can be interpreted as follows (Sangkanchanawanich, 2016)
   1) Primitive paradigm medicine: When illness occurs, the cure can be done by asking pardon from the Above and using a blend of rituals and drugs to relieve illness. The disappearance of the disease or the absence of disability, even death, is at the will of the Above.
   2) Ancient paradigm medicine: The principle that the world has law and that humans should know the laws for seeking happiness on earth. Life style is the seeking laws, the law of the nature, because they believe that success lies in the action according to the laws of nature. The medical practice of the ancient paradigm therefore focus on medical system, art of medicine and skill of the physician, if done and effective, then follow it,
   focusing on whether the person will be healthy, if the body and mind go together harmoniously to believe in emphasizing the balance of body elements, giving diagnoses and administering treatment with drugs for adjusting the balance of elements for the normal good condition. In the late of the ancient era, good healthy also included the how to behave and how to be happy.
   3) Medieval paradigm medicine: the belief that disease and cure is the test from God (Christianity – Islam). The doctor and the medicine just perform cure duties. the prayer is the best medicine. God is the best doctor. For Buddhism, sickness is a deterioration of element. People should not be emotional, but should make the mind accept the reality and live normally with that disease (Bunchua, 2003).
   4) Modern paradigm medicine: it is medical sciences by which most of the people believe that scientific progress will able to create medicines that treat all kinds of diseases or may eliminate the death and guarantee aging. Modern medicine emphasizes the diagnosis of the cause of the disease and treats directly the cause-symptom. So they focus on the development of modern medical instruments and technology. The Medical practice framework is the diagnosis, to treat first by the drug and/or surgery to the stage of cure from the disease. If the disease is incurable, it must be controlled and prevented from causing symptoms. Patients must therefore receive instructions and practice strictly according to the doctor’s order for good health and longivity.
   5) Postmodern paradigm medicine: the promotion of human right act and humanity drives both scientific and alternative medicine available for the people to make the choice for optimum health themselves. Holistic medicine is preferred to address the whole person -body, mind, and spirit–to prevent and treat disease, But they also use modern medical instrument and technology together to reach the level of good quality of life of patient.

Research Finding

1. The opponents gave supporting reasons to show that terminal stage patient care must be administered by the principle of modern philosophy (modern paradigm medicine) because of the reliability of the scientific process of treatment, accuracy of innovation, advance medical technology and the academic principles of patient care.
2. The researcher had the opposite opinion that such interpretations also have weaknesses that can be disputed. Because the conclusion of the opponents intentionally neglected the ethic of caring which is the cornerstone of the postmodern philosophy (Harimtepathip, 2018), especially the creative force, that is, the innovation of the medical technology that is rapidly advancing result from the creative force which thinks outside of the traditional scientific legacy of the modern philosophy , but dominate and often block the creativity that contradicts the laws of science.
3. The researcher had the reasons to support that postmodern philosophy which lied in the postmodern paradigm medicine applying to terminal stage patient because of its focus on ethic of caring and levering the intellectual instinct of the man with the postmodern forces (creativity, adaptivity, collaborativity and requisitivity) and 3-Dare principle in order to improve the quality of life of the patient, then the patient would satisfy themselves with levels 6-8 of modified Maslow’s hierarchical of need pyramid and had the authentic happiness according to reality.

Results and Discussion

1. The reasons that the opponents gave to verify that terminal stage patient care must be administered only by the modern philosophy paradigm were lined in the belief that the knowledge or truth that corresponds to reality must only come from research/laboratory experiments with scientific processes. The knowledge of theology or religion is a fool and of the lowest value. Even the philosophical knowledge is just pseudo-science and it was only the waitress of the science to explain science phenomenon in logical positivism that uses logic and mathematics as a tool to verify the truth (Harimtepathip et al, 2015).
2. Although the modern paradigm is ensured that the world and the universe have fixed rules and laws, and man could know the laws of the world and the universe through scientific methods along with creating academic language to communicate these truths from one to another. But after Einstein discovered the theory of relativity, it became clear to the world that the scientific laws that cite universality are not definite. Scientific truth is only information or facts that are accepted as only today truth, not sure in the future. Creative forces in humans mind can invent newer and newest answers that seem more sensible than the original answer. Scientific laws can always be changed. Therefore, the postmodern
   philosophy emphasizes not to attach to the laws as center again. The terminal stage patient care had to shift from modern to postmodern paradigm medicine and to focus on ethic of caring with postmodernism in order to improve the quality of life, both physical and mind, of the patient with human dignity.

Suggestions

1. Suggestions for application to the caring system
   It the patients fundamentally knows and understands themselves in terms of belief, liking, faith in the benefit of doing good both for themselves and society, they would know and understand themselves that they have abilities, interests, what good to do for themselves, and they would be happy and would be more happy if that doing made good to society. This is the intellectual instinct of those who make critical thinking along with the
   3-Dare principle to face any problems, choosing the good practice and take responsibility whatever they did and stepped up to the higher needed level such as levels 6-8 according to Maslow’s hierarchical of need theory. Level 6 is the need to get the aesthetic life, to have the ability to view the beautiful around them and to understand clearly that the environment and themselves are inseparable. Everything in the world is beautiful and has its own value. Level 7 is the need to reach their potential, to fulfill their potential, to succeed in something passionate, to progress in the development of skills maximized, to have independence decision in making and creative thinking, to succeed in work and profession. And the level 8 is the need to be a great person in dedication to mankind, to be
   a genius that can make the most benefit to all mankind and live for the others
   For the touch of aesthetics, the patients have to understand that they are capable to do good, what they had done in the past and what is going on, when they concern about the good they did, they will got happy. If they have the intention to do good in the future, they will get happy during the act of doing good. Finally, they will raise themselves to the highest ideal of life such as religious means and goal; even non-religious person, they will get happy from the act of their intention before the end of life. The key to get this happy is the capability of the intellectual instinct of man that projects out by the critical mind which analyses, appreciates and applies to themselves. (Phrakhruthammasaskhosit, et al, 2017) as follows:
   1. Analysis to distinguish information about disease, progress, treatment and self-caring method, resulted from the patient starting to dare to face with their problems and they will consider the benefit, cause-effect, cause-reason of each, then they can decide independently. In addition, the patient relatives and medical personnel can find the optimum way to care the patients.
   2.Appreciation makes the patients understand the true value that combine the goodness, beauty and benefits that are hidden within the illness situation. It is the courage/dare to evaluate the method of action/practice which one will make advantage/disadvantages, useful/useless, valuable-invaluable, and happy/suffering. Then they would bring the results of this appreciation to determine and decide which action should be avoided or which practice should be done. They will psychologically accept the illness and dare to live with it happily.
   3.Application by applying the above to the process, method, principle or
   innovation, to solve any problem among the illness and to prepare to cope with all situations, both desirable or undesirable with responsibility
   
   Finally, critical thinking promotion will shine to the patient mind. They will dare to confront with any problems, dare to touch their fear and panic, and dare to be with the reality of the illness. The patient will already live a life with responsibility and use 4 forces of postmodernism to reach their ideal in life. The good quality of life will happen in any physical, mental and spiritual element and the patients will have authentic happiness according to reality of their illness life.

2. Suggestions for future research
   The researchers have suggestions for the future research as follows:-
   1.1 there should be study of the application of postmodern philosophy and
   participatory healthcare.
   1.2 there should be study of postmodern philosophy and healthcare system development.

Reference
Bunchua, K. (2003). Philosophy in ordinary language. Bangkok: Saint John University. [in Thai]
…………………… (2008). Universal Ethics Handbook. Bangkok: Chain Printing. [in Thai]
…………………(2014). “84,000 Dhamma Khandhas are for scholars, not for educators”. SSRU Graduate studies Journal, 7 (1): 1-15.
…………………… (2017). Happiness from intellect knows itself. Retrieved on September 30, 2017, from https://thamdimisukh.wordpress.com/2017/07/31/%5Bin Thai]
DePoy, E., Gilson, S. (2012). Human Behavior Theory and Application: A Critical Thinking Approach. Thousand Oaks, CA: Sage Publications.
Harimtepathip, M., Bunchua, K., & Phramahamaghavinpurisuttamo (2015). Criterion of Truth According to Kalamasutta :An Analytic, Appreciative and Applicative Study . Rommayasan, 13(3), 69-78. [in Thai]
Harimtepathip, M. (2017). Maslow’s Hierarchy of need. Retrieved on July 8, 2017, from http://gotoknow.org. [in Thai]
Harimtepathip, M. (2015). Moderate postmodernism. Retrieved on September 30, 2017 from https://philosophy-suansunandha.com/2015/07/08/moderate-postmodernism/.%5Bin
Thai]
Maslow, A. (1970). Religions, Values, and Peak-Experiences. New York: Penquin.
Phrakhruthammasatkhosit, Harimtepathip, M., & Bunchua, K. (2017). The Moderate Way of Hermeneutics in the Noble Eight Fold Path: An Analytic, Appreciative and Applicative Study. Journal of Graduate Studies Review, 13(2): 110-118. [in Thai]
Rungnei, N. (2016). Health Assesment: A holistic approach. Nonthaburi: Thanaplace. [in Thai]
Sakloetsakun, D. (2006). Holistic Health. Retrieved on December 8, 2017 from http://oknation.net/blog/print.php?id=140405 [in Thai]
Sangkanchanawanich, W. (2016). The analysis of medical engagement in development of quality of life. Research report. Bangkok: Suan Sunandha Rajabhat University. [in Thai]
Sangkanchanawanich, W., & Suwanbundit ,A. (2016). Medical-People Engagement: Philosophical approach. Journal of Siriraj Radiology. 3(1), 63-70. [in Thai]
Takaew, R. (2014). Dee-Ngam: Analysis, appreciative, applicative study. Doctor of Philosophy Thesis. Bangkok: Suan Sunandha Rajabhat University. [in Thai]