In the West, a commonly used tool for dealing with grief is the memorial quilt, usually produced by sewing pieces of colourful cloth together. Each piece of cloth is prepared by an individual to commemorate a deceased loved one or a memorable experience.

In China, a similar tradition exists of sewing pieces of cloth together to make a quilt that is called the “cloth from 100 families” (bai ja bu, 百家布), but this quilt symbolizes a collection of blessings from families and friends to a newborn baby.

This chapter is our memorial quilt, a salute to the clients who are...

Palliative care is not about dying, and bereavement is not about crying. Rather, they are about connecting, caring, and respecting — the essence of living. If you dare to add some passion, you might even be seduced by them, as I have been. Health-care professionals involved in palliative care often find their work rewarding and inspiring, whereas others not familiar with its beauty often comment, “It must be so depressing!” In reality, caring for people who are dying can be enriching because every patient narrative is an experience from which we can reflect and learn. Over time, care-givers acquire flexibility in...

It is now generally agreed that coping with grief involves not only accepting the reality of death,¹ developing the ability to live without the deceased,² relinquishing old attachments to the deceased and the old assumptive world,³ and withdrawing emotional energy from the deceased so that it can be reinvested in other people and other things.¹ Coping with grief also involves staying connected with the deceased⁴ and developing a new relationship with him or her.⁵

This is the interactive perspective of grief work that guides our exploration of traditional Chinese death rituals and how they are practised in Hong Kong. Traditionally,...

Daoism, or daojiao 道敎 remains a central part of the daily life of the Chinese people in Hong Kong. The term “Daoism” has different connotations and content for scholars as well as believers in Daoism, including aspects relating to philosophical mysticism, mythology, immortals, nourishing life, meditation, and liturgies.¹ Daoism, in this chapter, is seen as a religious and liturgical institution profoundly rooted in the social life of local Chinese communities.

From Ming Dynasty (1368–1644) times on, Daoism comprised two main schools: that of the Orthodox Unity (Zhengyi 正—), passed on hereditarily since the end of Han Dynasty in...

Our lifespan is controlled by our biological clocks, which continually tick away. When they run down, there is little we can do to gain extra time. We must be prepared for the natural process of death. Death is inevitable. Many people believe death brings an end to everything. But, according to Buddhism, our life does not begin only at the moment of birth, and death does not imply the end of life: it is the beginning of another life. By doing good deeds in this life, a better future life can follow. This is the basic concept of Buddhist theory...

In 2003, 30,000 people died in Hong Kong. Out of these deaths, nearly 7,000 were reported to the Coroner by the doctors caring for the deceased persons prior to their death, or by the police, when the deaths occur outside a hospital. Table 1 shows details for the five-year period 1999–2003. Table 2 shows details of some of the types of unnatural death.¹

The death of a family member is in itself an emotionally difficult event and often gives rise to many religious, social and familial issues. When the deaths are reportable to the Coroner, more problems arise, such...

As Feifel¹ remarked, one of humanity’s most distinguishing characteristics is the capacity to grasp the concept of a “future and inevitable” death. The meanings of death and life are actually interdependent. Individuals’ perceptions of death affect their priorities and life choices; whereas individuals’ accomplishments, failures, changes and the cumulative effects of diverse experiences in life would also influence personal meanings of death.² Yet, only a limited number of research studies have focused on the personal meanings of death.

Among the studies concerned with meanings of death, many focus only on the developmental process for children to acquire the cognitive or...

Death is inevitable. But in view of this impossibility of further possibility, people still hope for “good death”. Different cultures may construct different definitions of “good death”, and Chinese culture is no exception. Our traditional Chinese philosophical and religious thought provides important cultural insights into the perception of death. Recent studies have tried to explore the meaning of “good death” in contemporary Chinese society.

Facing one’s own death and the death of significant others are stressful and traumatic events that will shatter our fundamental assumptions and question the meaning of death.^1,2,3 Reconstruction of meaning⁴ may be an important way to...

Palliative care has been developing in Hong Kong for more than twenty years, gaining wider coverage and more sophisticated service.¹ The modes of delivery include in-patient care, home care, out-patient care, day care and hospital consultative services, looking after cancer patients as well as patients in the advanced stage of other diseases such as HIV/AIDS.

Nonetheless, for any patient, the personal experience of the last journey is always an individual one. This is reflected by struggles that patients, family members and health-care workers face during the transition from curative to palliative care. The transition of the goals of care from...

Good comfort care for dying patients at the final stage of life is crucial, though of course palliative care does not begin only from the countdown of the patient’s last month. Palliative care should commence right from the moment of the diagnosis of any incurable illness that is expected to deteriorate with inexorable progression. It is essential to ensure early integration of the palliative care component, with a smooth transition from an active curative intent to a palliative emphasis. Indeed, it has been recently advocated that palliative care should begin even at the pre-diagnostic phase, when cancer is suspected pending...

Introduction Euthanasia is derived from the Greek euthanatos, which means a good or peaceful death.¹ There have been many definitions of the term, and many forms of euthanasia have been described, including active euthanasia, passive euthanasia, voluntary euthanasia, non-voluntary euthanasia and involuntary euthanasia. When used without qualification, the term euthanasia usually signifies “voluntary active euthanasia”.² Euthanasia is illegal in most parts of the world, except in the Netherlands and Belgium, where euthanasia was legalized in April and May 2002 respectively. Physician-assisted suicide is similarly illegal in most parts of the world, though it was legalized (but not euthanasia) in the...

The purpose of palliative care is to enhance the quality and meaning of life and death for both terminal patients (those with cancer or non-cancer disease) and their family members and in their bereavement period. As a modern health-care specialty, palliative care has rapidly developed in the last decade in Hong Kong. The Co-ordinating Committee (Hospice) of Hospital Authority (HA) of the Hong Kong SAR Government defines hospice/palliative care as¹ “the care of the patients & their families with active progressive advanced disease and a limited prognosis for whom the focus of care is the quality of life”.

The terms...

Despite rapid advancements in medical science, a number of complementary and alternative medicines (CAM), including Chinese medicine, remain popular. According to WHO¹ figures, seventy-five percent of people in a number of developed countries used CAM in 1997. In the US, it was estimated that the percentage of Americans using CAM increased from thirty-two to forty-two percent between 1990 and 1997.² The types of CAM include Chinese medicine, chiropractic, naturopathy, homeopathy, and Indian Ayurvedic medicine. A population-based survey in San Francisco indicated that seventy-two percent of women with breast cancer used at least one form of CAM.³ Although most of them...

On several occasions during training workshops with health-care professionals, Lee was asked: “How can I be really helpful, involved and caring towards my patients, yet at the same time not be (emotionally) affected or feel bad in any way when they die?”

Kwan made the following observations:

My ICU [intensive care unit] patient just passed away. I had to perform post-mortem care. This patient of mine, a “man” with a human name moments before, now became a lifeless “it”— a mass of flesh. The pale white body felt cold. I removed all lines and tubes and gave “it” a quick...

The hospital is an amazing place where most of us are born. It is supposed to be the place for quick fixes when we are injured or sick. Advanced medical technology can save lives and relieve human suffering most of the time. Yet, this miracle place may fail us when patients die. Though death is a certainty of life, not every one of us acknowledges this fact. After hearing the bad news^1–4 of a life-threatening illness or injury, the family and patients have to face and prepare for impending death. The time between hearing the bad news and death...

Introduction Childhood cancer is one of the ten leading causes of death among children in China. Blood-related cancers such as acute lymphobastic leukaemia (ALL) and acute nonlymphobastic leukaemia (ANLL) are the most common types.^1–3 It is estimated that there are around 13,000 to 15,000 new cases of blood-related cancer in China each year.⁴ The treatment of and research on childhood cancer are both disappointing and encouraging. The disappointment stems from the majority of new cases not receiving proper treatment for various reasons, such as wrong diagnosis, poor treatment protocol at hospitals in mid-size cities or rural areas, and lack...

Death marks a permanent separation from our loved ones. It hurts because we are socially, emotionally and psychologically attached to the deceased, and our loved one may feel like a part of us. His or her death is equivalent to the amputation of a limb from our body. It is an irreversible loss. As there is no Chinese term to describe bereavement, we use the literal translation of “the experience of losing a dear one” (喪親的經驗).¹ Death is a taboo subject that is also not frequently mentioned² and is always replaced by euphemisms. The absence of a Chinese concept of...

Bereavement can be understood as a social construction.¹ It is shaped by our current socio-cultural environment. A mourner constructs and makes sense of grief within the cultural and social context. Therefore, in order to understand one’s grief, it is important to first understand the socio-cultural environment. However, it should be noted that our environment is ever-changing and we are always in a process of revising our thoughts and feelings. Therefore, the following is not an attempt to simplify the characterization of the Chinese culture or to imply a static cultural pattern. It serves to highlight briefly a part of Chinese...

The Jessie and Thomas Tam Centre of the Society for the Promotion of Hospice Care, the first community-based bereavement counselling centre in Hong Kong, established in 1997, has adopted group work as one of the main intervention modalities in supporting bereaved clients. By understanding the conceptual framework of bereavement groups, as well as the grief process from an interpersonal and cultural perspective, this chapter discusses the working mechanism and the implementation of the bereavement group in helping bereaved people through their bereavement experiences. Group work has been found to be an important and effective modality in bereavement counselling. A structured...

Volunteer participation is widely developed in many sectors in Hong Kong. To volunteer is to give service willingly of one’s own accord. Volunteers give their time, skills, thoughts and talents to contribute to the community, without any monetary reward. Volunteering is probably a feature of an affluent society, but it is also a mark of a society in which the people are lucky and want to give some of that luck by doing things for those who are less fortunate. Volunteers form an integral and enriching part of hospice palliative care all over the world.¹ Is this also the main...

Although suicide may appear to be an individual decision and action in ending one’s life, the effect and the subsequent pain of bereavement on family members may be phenomenal. Suicide bereavement has a higher chance of eliciting complicated bereavement responses^1,2 than do other forms of bereavement. The focus of studies on suicide is mainly on attempters. Shneidman alerted the public to the needs of bereaved family members or friends of deaths due to suicide. He introduced a new term, “postvention”, a combination of “prevention” and “intervention”, to form a comprehensive working approach to suicide.³ “Postvention” is the supportive intervention particularly...

We can learn about life through the death of our loved ones.² Knowing death reminds us of the treasures in life, the importance of relationships as well as our connectedness with people and nature. The journey of loss and grief can be a joyous one if we can cultivate a sense of awakened awareness of unpredictability and vulnerability, learning to be mindful with non-attachment and freedom, non-possessiveness and yet with compassionate loving-kindness towards self and others, true respect and genuine appreciation of life and beauty.

After going through the various chapters on death, dying and bereavement in Hong Kong, we...