The norms of Chinese culture.
In Chinese culture, three major religious systems shape Chinese beliefs and practices: Buddhism, Confucianism, and Taoism (Fersko-Weiss, 2018). Confucianism provides the concept of filial piety, where it is one’s duty to provide care for one’s parents. Taoism provides the concept of energy or forces affecting an individual. Buddhism provides the concept of life and death as a continuous cycle or reincarnation.
The primary decision-maker in the family is the father or eldest son; however, decisions are made collectively as a family (Fersko-Weiss, 2018). The Chinese view illness through the naturalistic or holistic paradigm, where it is believed that one’s health is based on the forces of nature that must be balanced and in harmony. The concept of yin-and-yang energy attempts to explain that one’s health is the balance between these two forces, an imbalance between the two forces signals or manifests into illness (Hinkle, Brunner, Cheever, & Suddarth, 2018).
The yin-and-yang forces influence how the Chinese deal with their illness through diet. When one is experiencing a hot illness such as a fever, rash, sore throat, ulcer, or infection, to re-establish the yin-and-yang balance cold foods are eaten (Hinkle, Brunner, Cheever, & Suddarth, 2018). When experiencing a cold illness such as cancer, headache, stomach cramps, or cold, hot foods are eaten.
Death and dying
Under Confucianism, if an individual lived a moral life, then he or she should not be afraid of death. Under Taoism, an individual is taught to view and accept death as a natural part of life, and if the same individual lived a moral life then he or she will achieve immortality in the afterlife (Fersko-Weiss, 2018). Despite these beliefs in accepting death as a part of one’s natural life, death and dying are viewed as taboo subjects where discussing death and dying are frowned upon and considered disrespectful.
According to the article, “What Matters Most at the End-of-Life for Chinese Americans?” the research found Chinese Americans considered the following wishes to be considered important factors in their end of life or what they would constitute as a good death are: (1) to be free from pain, (2) not being a burden to my family, (3) to have my family with me, (4) to trust my doctor, (5) to maintain my dignity, and (6) to pray (Lee, Hinderer, & Alexander, 2018). When it comes to the concept of being free from pain, the researchers found that Chinese Americans “believed pain came not only from illness and disease but also could be from treatments…Regardless of intent, being pain-free at the end of life was very important.” Second, Chinese Americans do want to become a burden to their family, which can include financial, physical and/or emotional burden. Despite not wanting to burden their family, Chinese Americans express that they want their family present before they die, family presence provides the person a sense of security and comfort; having family at their end of life is considered a blessing. Prayer provides inner peace, it is also a time where they can forgive and forget the wrongs that were done to them by others.
Healthcare providers should approach Chinese patients regarding the end of life issues with the whole family. A dying Chinese patient may defer decision making to he/her/their family; on some occasions, the family unit may decide without input from the dying patient (Fersko-Weiss, 2018).
Practices and ceremonies
Before the body is placed in the casket the body is washed, dusted with talcum powder, and then dressed in the dead person’s finest clothes (Fersko-Weiss, 2018). The deceased should avoid being dressed in the color red because the Chinese believe this may turn the deceased into a ghost. Women are buried with jewelry, and men are buried with coins. For the individual who practices Buddhism, his or her face may be covered with a yellow cloth, which symbolizes the person is free from problems and concerns of the physical world, while the body is covered with a blue cloth, which symbolizes harmony and immortality.
In the event a Chinese person dies at home, the family will perform a thorough cleaning of the home, which may include:
“Opening all the windows, removing photos of the deceased, sweeping and washing the floor and walls, even painting the room. The bed and mattress will be replaced and all of the clothing from the deceased will be given away. In a traditional family, the clothing will be burned… all statues of gods will be covered in red paper. Red is the color of good fortune and vitality. A white cloth will be hung outside the front door of the house to announce that the family is in mourning. White is the color the unknown, purity, courage and strength” (Fersko-Weiss, 2018).
This cleaning is performed to purify the home of the negative energy or bad luck that was left behind from the death of the deceased.
Restriction regarding organ donation
For those who practice Buddhism, organ donation and an autopsy are forbidden. For the Taoists, organ donation and an autopsy is also forbidden because doing so will “break the integrity of a body” (Cai, Yu, 2013). For those who follow the Confucian principles may be for or against organ donations and an autopsy. On one end of Confucian school of thought is “the body, hair, and skin are given by the parents, and one should not damage them” (Cai, Yu, 2013), here one can interpret why there is no support the idea of organ donation or autopsy because doing so will be a sign of disrespect to one’s parents. On the other end of Confucius school of thought is the emphasis on the “importance of family…implies a firm commitment to and love for one’s relatives” have been interpreted and used in some cases by Chinese families to undergo living organ donations to “save close family members or even other relatives”. (Cai, Yu, 2013)
- Cai, Yu. ‘On the Impacts of Traditional Chinese Culture on Organ Donation.’ Journal of Medicine and Philosophy 38.2 (2013): 149-59. Web.
- Fersko-Weiss, H. (2018, March 11). The Chinese Approach to Death and Dying. Retrieved October 2, 2019, from https://www.inelda.org/the-chinese-approach-to-death-and-dying/.
- Hinkle, J. L., Brunner, L. S., Cheever, K. H., & Suddarth, D. S. (2018). Brunner & Suddarths textbook of medical-surgical nursing. Philadelphia: Lippincott Williams & Wilkins.
- Lee, M. C., Hinderer, K. A., & Alexander, C. S. (2018). What Matters Most at the End-of-Life for Chinese Americans? Gerontology and Geriatric Medicine, 4, 233372141877819. doi: 10.1177/2333721418778195