MA VisualMedia Li Bu
China's Hospice Care
On Going Campaign
BY : BULI
Director Cheng shared an experience of recommending palliative care to the family of a late-stage cancer patient and the suffering the patient endured in the ICU:
"I once encountered a patient with prostate cancer that had metastasized throughout his body. I assessed the situation and realized that things were not looking good. My judgment was that the patient probably had at most 24 to 48 hours left. Bone metastasis is very painful, so for his comfort, I suggested transferring him to the hospice ward, where he could receive some pain relief and other supportive care, allowing him to peacefully spend those last 24 to 48 hours.
However, the family refused. They said they didn’t care if he was in pain; they just wanted to see him live one more minute, so they could feel better. They insisted that we make every effort to resuscitate him, no matter how many tubes were inserted into his body. For them, prolonging his life by even one more minute would bring them comfort. They accused us of being irresponsible with life, saying that transferring him to the hospice was equivalent to giving up on him. They even threatened to report us to our superiors.
Since they insisted on resuscitation, I stayed with them and did everything I could. I spent 36 hours straight, constantly resuscitating him. The patient’s body swelled up like a balloon, glistening and icy cold, with his skin so tight that when you touched him, fluid would seep out. Any contact with his skin caused him to cry out in pain, wailing in agony."
Doctor Cheng：I would choose to control my condition with the least amount of medication and treatment, and then focus my energy on enjoying the last moments and living the rest of my life happily. I can't remember how many doctors and colleagues have told me that if one day I become like this, please kill me (please let me die peacefully).
Doctor Cheng: One time that left a deep impression on me was when a late stage cancer patient asked for my advice and I said, "Buy a boat ticket to travel around the world.". As a result, the patient's family complained about me. Not long after, the patient sold the house and came to be hospitalized. Not long after, the hospital bed changed to a bedsheet and the person passed away.
The Death Quality Report released by The Economist Intelligence Unit in 2023 shows that among 80 countries and regions surveyed globally, mainland China's death quality index is only 23.3 percent.
Between 60 percent to 80 percent of healthcare expenses over a person's lifetime in China are spent on treatment in the final month before death. There is considerable room for improvement in the quality of death in China, and in recent years, dignified dying has attracted increasing attention from various sectors of society.
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Palliative care aims to provide physical, psychological, and spiritual care and humanistic care services to end-stage patients by minimizing their pain and discomfort symptoms, in order to improve their quality of life and help them pass away peacefully, and with dignity.
In an ideal state, it is up to the patient to decide whether to receive palliative care. “The 14th Five Year Plan for the Development of National Elderly Care and the Elderly Care Service System” proposed that hospice care should be carried out in accordance with the principle of patients being fully informed and voluntarily choosing. However, due to factors such as decreased decision-making ability of patients and adoption of protective healthcare, family members are often the main decision-makers in hospice care.
In China , one of the most important factors leading to the slow development of hospice care is cognition.
According to Professor Jing from the Department of Sociology at Tsinghua University and Director of the Public Health Research Center at Tsinghua University in 2018, a total of 28,300 people in China received palliative care services. In the same year, 2.56 million cancer patients died in China, with a total death toll of over 8 million. Calculated, the nationwide popularity of palliative care was only 0.3 percent.
In traditional Chinese beliefs, death has always been considered a taboo topic to discuss. People believe that death is unlucky, so they cannot face it calmly when it comes. Family members are often accused of abandoning thier relatives if they do not put them through proper treatment when they are sick.
Chinese people's views on life and death and family relationships, can sometimes lead to children bearing the blame of "unfilial piety". Relatives also prefer emotional treatment intervention, sometimes disregarding the patient's own wishes. When they are unwilling to accept the departure of their loved ones, they ask doctors to continue treatment, even if in some cases, it could bring more pain to the patient.
Don't be afraid，
I will Stay with You！
When a loved one faces the late stages of cancer, being present becomes the most crucial form of support. At this time, the patient’s body is often extremely weak, and they may be enduring intense pain and emotional fear.
Mrs zhao, whose parents-in-law are currently in hospice care says that as family members, providing companionship is not just about offering physical care but also emotional comfort. She says that having loved ones nearby can provide immense psychological reassurance, allowing the patient to feel deep love and care.
She sayd that during this period, family members can help alleviate the patient's sense of loneliness and helplessness by being there, offering emotional support, and making them feel that they are not alone. This companionship serves as a silent source of strength, helping the patient to face the illness with greater resilience and, to some extent, even reducing their suffering.
Hospice Care ≠ Filial Impiety
In traditional Chinese culture, filial piety is often associated with prolonging life and making every effort to save loved ones. However, with the advancement of medicine, people are gradually realizing that excessive treatment may not extend a life of quality but rather increase the patient's suffering. Choosing palliative care does not mean abandoning love and responsibility for one's family member; instead, it allows the patient to receive better care and comfort in the final stage of life. True filial piety is about respecting the wishes of loved ones, alleviating their pain, and helping them pass away with dignity. This choice reflects a deep understanding and respect for life, rather than indifference or avoidance.
How to "bid farewell"
Palliative Care in China is still a contentious issue, although attitudes are changing slowing and the number of beds available increases the country still remains a long way behind countries of a similar economic standing in the world.
According to Dr.Zhang, this is not only a way to honor the last stage of their life but also a deep expression of the bond we share with them. He adds that no matter how small or simple these wishes may be, for the dying, they carry their unfulfilled hopes and lingering attachments.
“At the end of life, a loved one’s wishes are often their final requests to the world. By listening with care, understanding their desires, and doing our best to fulfill them, we can bring them a sense of peace in their final moments and alleviate some of our own regrets. The process of fulfilling these wishes is also our last intimate interaction with them, helping us face the eventual farewell with greater calm and acceptance.”
While expensive hospital treatment is often seen as a sense of responsiblity among family members, there are also families who want to honour the wishes of their dying relatives by giving them the care they desire.
Dr Zhou says: “As we fulfill their wishes, let us also take the time to properly say goodbye. Express the love and gratitude that we may have left unsaid, allowing them to feel the warmth and care one last time.” He adds, “This moment is not only a complete farewell to our loved one but also a form of inner redemption and comfort for ourselves.”