People only experience death once in their lifetime. Without any previous experience, no one can face it fearlessly. To help people deal with dying in a more dignified way, the ideas of "hospice care," "dignity death" and "euthanasia" are starting to be promoted in China, according to the Jiefang Daily.
In Shanghai, cancer patients approaching the end of their life can now choose to prepare for death at a local hospice care center. There are 76 hospice care centers scattered around the city.
Among them, a community health service center on Linfen Road in Jing'an district was the first registered hospice care center in Shanghai. A total number of 168 cancer patients died there in 2015.
Pan Jumei is a doctor at this hospice. She told the Jiefang Daily that the main responsibility of doctors and nurses at their center is to relieve the pain and sooth the nerves of patients with advanced stage terminal illnesses while accompanying them on their last stage of life.
This morning Pan was busy the moment she arrived for work. She was informed that two patients that previously planned to move into the center had passed away the day before. But she still needed to help another two patients check in.
According to her, when new patients move in, their personal information, along with their illness and - most profound - an estimation of the patients' remaining days, are written in a chart. "The time we estimate usually is accurate," she added.
She then must consulate with patients' family members in her private office. "You need to get mentally prepared that your family member will die soon. Once they moved in here, they are not likely to stay alive much longer," Pan said. "Your mobile phones should be on 24 hours. When your family member becomes terminal, we will inform you immediately."
Let them go
Pan must also explain to patients' family members that their center is not equipped with any rescue devices; once a patient starts to hemorrhage (or whatever other illness they are suffering from), the doctors let them die.
Pan explained that their center only receives cancer patients whose remaining lifetime is less than three months. "Most of our patients have tried every possible medical treatment at other hospitals. So they tend to be already prepared for imminent death."
Wang Qin is currently a patient at Pan's hospice. She has been diagnosed with advanced breast cancer. When she moved into the center, her score of life quality was above 50, but since then her score has declined to 40. The nurse looking after Wang told the reporter that Wang's cancer cells have spread to her brain, which makes Wang unconscious most of the day.
"She cannot utter a word now. But from her facial expressions I can tell she is very anxious. She seems not yet reconciled with death. Her daughter-in-law just became pregnant so she must be eager to see the baby. But I fear she will not live that long," the nurse said.
Wang's husband comes to the center almost every day to look after his wife. "If I had late-stage cancer, I would rather swallow lots of sleeping pills to immediately end my life rather than suffer from tremendous pain," he said. "But since it's my wife, I just don't want to let her go." Wang's family has spent approximately 500,000 yuan ($72,683) on her entire cancer treatment.
Free myself from pain
Lying beside Wang is another female patient, Xu Jingli. Xu told the reporter that she is no longer afraid of death and wants to die as soon as possible "to free myself from the pain brought on by cancer."
Xu's doctor, Pan Jumei, told the reporter that Xu's cancer cells have already transferred to her liver, lung and stomach; she is very likely to pass away soon. Until then, Pan uses morphine to relieve Xu's physical and mental suffering. But Xu refuses to take too much morphine, as she is worried that she will become addicted to the drug.
"In fact, patients at Xu's late cancer stage don't even have enough time to become addicted to drugs. They usually will die before their bodies become physically addicted to medication," Pan explained.
Most hospice doctors and nurses are under heavy mental pressure. Pan's colleague, Hei Ziming, said that he felt depressed after he first started working at their center due to having to witness so many deaths on a daily basis. But over the years he gradually understood the real meaning of his important work.
But other colleagues have not lasted as long. "One colleague witnessed a child patient passing away after great physical agony. Since that colleague was a mother and had her own child, she broke down after seeing the kid die," Hei said.
Apart from hospice care, the notion of "dignity death" has become more popular in China in recent years as greater awareness of this type of treatment has reached the public. Dignity death means that an individual can follow his or her own will to live or not live.
They can also choose to give up medical treatment and refuse life support if they slip into a coma; the person's death will thus come completely naturally and their life will not be artificially revived.
Beijing Living Will Promotion Association, for instance, is a pioneer in this field, with their main mission to promote "choice and dignity." Chen Xiaolu, son of the late Chinese military commander Chen Yi, is the president of this association. His motivation, he said, was inspired by his own father's death.
"When my father was tortured by cancer, I asked his doctor not to give him anymore painful radiation treatment and just let him go. But the doctor refused, saying doctors do not have the right to decide to save or not to save a patient's life," Chen said.
Another founder of the association, Luo Diandian, said that she has been thinking about how to reduce people's physical pain and mental suffering during the last days of their life and believes dignity death could be a solution.
According to Luo, euthanasia is difficult to apply into medical practice in China due to China's legal complex system and cultural values. "Though euthanasia was introduced long ago, Chinese government officials and law experts still believe that the practice doesn't suit our current social environment," Luo added.
Suicide themselves
Compared with euthanasia, Luo believes dignity death is more likely to be accepted in China. "Every individual has a different understanding of dignity and death, and the idea actually encourages people to make their own choices about life after careful consideration: whether it is to end their life to avoid extra agony or to seize every possibility to live regardless of cost."
The association also encourages cancer patients to prepare their wills, which allows individuals to express their healthcare desires when they lose their capacity to give informed consent.
So far an estimated 20,000 individuals have written their living wills on the association's website. According to Luo, a person can change his or her own will at any time.
Though euthanasia is not likely to be adopted in China anytime soon, some individuals still believe such a right should be available for patients who suffer from great pain and have no human possibility to live for long.
Fang Jiake, vice president of the China Association of Social Welfare, is also a proponent of euthanasia.
He suggested that cancer patients with advanced tumors tend to secretly "suicide themselves" to avoid further torture from disease and chemotherapy. This, he said, leaves their family members in even greater shock and sadness.
"If euthanasia becomes legal in China, it will be a good thing for both patients and their families," Fang added.
Similar ideals were echoed by 80-something Cui Yitai, a pioneer of hospice care in China. Cui argued that it is a great torture for cancer patients to sustain their life; instead of living their last days in great agony, euthanasia could allow them to die more comfortably.
