On ethical locations: the good death in Thailand, where ethics sit in places

In this article, I use ethnographic data on end-of-life care in Northern Thailand to address the relationship between ethics and place. My analysis is based on fieldwork conducted in 2007-2008, consisting of twenty in-depth oral life-histories of dying patients; ninety-five interviews with patients, family members and caretakers; fifty-four interviews with providers, administrators, civil society leaders and other key informants; as well as participant-observation of care of patients at the deathbed. In Northern Thailand, many feel that it is ethical to withdraw life support in the home, but unethical to withdraw it in the hospital. This is because the place of death is partly responsible for the quality of rebirth. Hospitals, on one hand, are powerful for saving lives; but as places to die, they are amoral, dangerous, devoid of ceremonial history and haunted by spirits. Homes, on the other hand, are optimal for dying because they are imbued with moral power from a history of beneficial ceremony and family living. Hospitalized patients at the edge of death are often rushed home by ambulance to withdraw life support in the more ethical place. I argue that the two places can be considered different ethical locations, because each is inhabited by a unique ethical framework governing withdrawal of life support. This concept has implications for the contemporary globalization of bioethics and for understanding practices that arise around ethically charged decisions.