Why you should care

Encouraging conversations around death would help people and their families prepare better for life’s one certainty. 

Like much of the world, China has a death taboo. The number 4 has a phonetic similarity to the Chinese word for death, so most buildings omit floor numbers that include 4. Giving white flowers is considered insensitive as the color is associated with death. A saying in China goes, “Do not name the dead,” meaning people regularly grieve in literal silence.

But China’s ultraconservative society — so queasy about sex and sexuality that the national curriculum largely doesn’t even teach youngsters about the birds and the bees — is the unlikely scene for a popular movement in support of death education. And communities across the globe, both online and offline, should follow suit in bringing this debate to the masses.

The conversation around death education has been largely confined to academic circles. But in March, it broke into the mainstream in China after Dr. Gu Jin, the highly respected chief physician at Peking University’s Cancer Hospital, proposed the introduction of nationwide death education in primary and middle schools at a government policy meeting. He also proposed special death education for late-stage cancer patients. He had watched family members refuse to accept a terminal diagnosis. With greater respect for death and a deeper appreciation of the benefits of palliative care, the process could be much less painful for all involved, he argued. Weibo posts mentioning the proposal were viewed 340 million times in the next 24 hours.

This would reduce fear and stigma.

Catherine Beckett, Northwest Association for Death Education & Bereavement Support

Jin’s proposal came just before China marked the Qingming (or Tomb Sweeping) Festival, where family members in China honor their ancestors, early this month. That timing helped ensure that several newspapers — including the communist party mouthpiece Global Times — picked up the discussion around death. His comments have also sparked broader debates, such as on the legalization of euthanasia. 

In essence, death education involves making people feel comfortable discussing the realities of death openly with loved ones. Such a shift relies on people accepting death as an inevitability. And that’s something most of us do very badly. Western experts have sporadically pushed the idea of nationwide death education including the Australian Medical Association Queensland in May 2018. But no Western country has come close to exploring a national curriculum in the way China has.

Breaking the taboo around conversations about death means people are more likely to discuss estate planning, organ donation, end-of-life care and the value of palliative care. I knew of these issues but hadn’t put much thought into them before China’s new debate.

 

“When people feel uncomfortable or don’t know what to say, they often default to saying nothing at all,” says Catherine Beckett, education and training chairperson for the U.S.-based Northwest Association for Death Education & Bereavement Support. She says the first step is to bring the conversation to the table. “This would reduce fear and stigma and allow for more conversations about the various kinds of support that may be needed, increasing the likelihood that support would be available,” she says.

Avoiding the subject of death is still an intrinsic part of Chinese society too. Families are often reluctant to make the decision to transition loved ones to palliative care, pushing for proactive medical care long after it stops being viable. This is driven by a fear of abandoning their filial duty, or at least being perceived to do so. Producing a last will and testament is still not commonplace in China. Only about one in 5,000 people in China are registered volunteer organ donors, compared to over half of Americans.

All of this puts huge pressure on surviving Chinese family members to make decisions that could have been avoided if the deceased had talked more openly about their wishes while still alive. If the debate can gain mainstream interest in a country with this social context, there’s no reason why this can’t happen in other societies.

Delivering such education is considerably more difficult than recognizing its merits. There are multiple organizations that advocate for death education and provide related services — such as the U.S.-based Association for Death Education and Counseling (ADEC). But a major obstacle they face in making death education widespread is the desire among many parents to protect children from the harsher realities of life.

Phyllis Kosminsky, incoming president of ADEC, says he understands parents’ concerns but believes “we would better serve them [children] by allowing them to understand, in an age-appropriate way, that whatever lives eventually dies.”

But American society isn’t yet ready, she suggests, for death education as a mandated part of the national school curriculum, and such a proposal could at the moment prove counterproductive. “I am not going to argue that we should require death education,” she says. “I don’t want to set myself up to be bloodied by the online mob.”

Even a debate on death education though is a start. And on China’s raucous social media platforms, the debate hasn’t led to the kind of online mob targeting Kosminsky fears in America. By learning from China’s example, more of the world could plan better for one of life’s few certainties.

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