Population aging, medicalization of death and death education in China

Abstract

Since Professor Duan Dezhi opened the course of Death Philosophy at Wuhan University, the development of death education in China has a history of more than 30 years. But it has lacked the clout it deserves in China. However, in recent years, death education has begun to attract more and more attention from the medical community. Various lectures and pieces of training related to death education held by the government and medical institutions, as well as related academic salons, seminars, workshops and “Death Cafes” held by the people have appeared and become popular. Death education has been developed in China for more than 30 years, why has it suddenly become popular and even popular in recent years? This has an important relationship with China’s aging population and the medicalization of death. The research shows that China has entered the aging society since 2000 [1], and has entered the deep aging society so far [2], which brings many challenges to China’s social development. One of the key challenges is that a large number of older people are approaching the end of their lives and are in urgent need of care services. The kind of service they need is not only general life care, but also comprehensive physical, mental, social and spiritual care at the final stage of life. This means that with an aging population comes an increased demand for hospice services. The reason for this is that the aging of the population in China is not only a natural change in the population structure, but also a rapid increase in the absolute number of the population. This is mainly due to the fact that China has experienced three birth peaks in its history, namely, 1950-1958, 1962-1975 and 1981-1994, with an average annual birth population of 22.77, 25.83 and 22.39 million, respectively. It is inevitable to form three population aging shock waves [3], resulting in a substantial increase in the elderly population. Secondly, rapid population aging will directly increase the number of people with high incidence of malignant tumors, resulting in a rapid rise in the number of cases and deaths [4]. Due to the maximum life expectancy of the population, combined with deaths due to malignant tumours, the aging of the population will inevitably lead to more deaths, and therefore will inevitably increase the demand for hospice services. However, the need for hospice is one thing, the actual acceptance and use of hospice is another. The lack of death education and the inability to freely discuss and plan end-of-life arrangements can actually affect the acceptance and use of hospice services, or if hospice services are available, they are not considered until too late, such as two weeks before death, resulting in too little benefit for patients. The theoretical and practical circles of hospice care are well aware of this, so when the National Health Commission vigorously promotes hospice care, death education has gradually become a popular science in China. The medicalization of death is a natural product of the rapid development of modern medical science and technology. Due to the rapid development of medical technology, medicine has gradually penetrated into People’s Daily life, and non-medical problems in life are often defined as disease problems or obstacles in the medical sense and treated, this process is called medicalization [5]. It embodies the special social process of how non-medical problems are transformed into medical problems. Such a social process inevitably affects the Death of people in modern society and evolves into the Medicalization of Death, which means that death is regulated and restricted by medical values, norms, behaviors accepted by medicine and doctors’ leading role [6]. As a result, medicine controls the death process. Overcoming death has become one of the important goals of modern medical development. Originally, death was a natural phenomenon, but medical intervention made this phenomenon no longer natural. Death without medical intervention becomes an abnormal death. The “ICU patient image” is the product of the medicalization of death, which has become the normal death scene of people in modern society: the patient is filled with tubes, the body is extremely weak, the ECG and EEG monitoring instrument at the bedside always reports his physical signs to the medical staff, the nasal feeding tube supplies the nutrition he relies on, and the ventilator provides him with oxygen. He could not move, not even the slightest movement to turn over. There are no loved ones around, except at short notice when they get hospital privileges [7]. However, through this modern death scenario, the patient’s family satisfies their emotional needs to keep their loved ones, and the medical staff satisfies their needs to fulfill their professional responsibilities and avoid being blamed or sued by the patient’s family, but the patient not only fails to meet any of their own needs, but has to bear the physical and mental pain and loss of dignity caused by excessive medical treatment. How to avoid this kind of modern medical tragedy, which is for the sake of the patient but makes the patient suffer deeply, is the problem that death education tries to solve. For the above two reasons, death education has become a hot trend in China. On the one hand, the number of schools offering death education courses or lectures for all kinds of students is increasing. On the other hand, at the social level, such as in the community, in hospitals, in funeral homes and in relevant online interest groups, lectures, exhibitions and dialogues on death education are being held. And themed activities such as workshops and “Death Cafes” have become more and more frequent. Especially in hospice lectures and training, lectures on living wills, grief counseling, family meetings on death, and how to talk to patients and their families about death are almost a staple. In addition, the National Health Commission issued a letter on December 28, 2022, on the Fifth meeting of the 13th National Committee of the CPPCC proposal No. 01952, which clearly stated that “the Ministry of Education will encourage and support colleges and universities to take the initiative to adapt to the needs of high-quality professionals in the development of China’s hospice care cause, and open courses related to death education and hospice care [8].” There is no doubt that such a state organ’s response to the CPPCC member’s proposal will greatly encourage universities to develop death education. The aging of the population and the medicalization of death put forward an urgent need for the development of death education, while the trend of social development and the country’s emphasis on hospice care will promote the development of death education in China. We believe that in the next two decades, China will usher in the development of death education climax.