The Chinese Approach to Death and Dying
In the Chinese American family you will find a mixture of traditional beliefs that date back centuries, and more modern attitudes that reflect western ideas. Beliefs and practices in China relating to death and dying have been impacted by the country’s three dominant religions: Confucianism, Taoism, and Buddhism. Although the Communist Revolution of 1949 and the subsequent Cultural Revolution in the mid 1960s to 70s made it nearly impossible to practice religion in China, values and customs from all three of those religious have seeped into Chinese culture. Immigrants to the U.S. brought those values and customs to America where they have mixed with Christian approaches to death and dying.
Confucianism and Taoism have had the greatest impact on Chinese thinking and practices because of their native roots. They both express a philosophical understanding of life and death as well as a religious belief system.
In the Confucian understanding a person shouldn’t be afraid of death, if they live a moral life according to the dictates of Tien Ming, referred to as “heaven.” But this use of the word “heaven” doesn’t denote some afterlife place the soul goes to. It should rather be understood as the underlying mechanism that controls life. Confucius didn’t explicitly discuss an afterlife, eternal life, gods, or spirits.
Taoists see death as a natural part of life that we all must accept. If a person lives a moral life and follows the path of Tao, which involves various meditative exercises, they will achieve immortality after death. For Taoists, life is an illusion and death is an awakening.
In spite of seeing death as a natural part of life, Chinese think talking about death will upset the inner harmony that is so important to maintain. So, Chinese try to avoid even thinking about death.
Filial piety and ancestor worship are important principles of both Confucianism and Taoism, and may even predate those religions in Chinese thought. According to those principles, children must respect their parents and ancestors and take care of them. As a result, here in the U.S., children of a dying Chinese parent may push for aggressive treatment throughout an illness to honor their duty to that parent.
The Chinese have great respect for doctors. They believe they should be trusted and listened to in all matters that relate to care of the sick. So doctors are not questioned and will often make decisions that in other families would be made by the dying person or the closest relative. Elders may even listen to a doctor over the advice of their children. The whole family will make caregiving decisions that go beyond the medical. So, unlike the western principle of autonomy of the individual, a dying person will often defer to the family. Therefore, naming a healthcare proxy may be seen as unimportant or even contrary to the best approach for decision-making.
Among first generation Chinese in the U.S. traditional Chinese medicine is still the most common form of healthcare. That includes the use of herbs and acupuncture. The focus of Chinese medicine is to restore balance of the life energy that flows throughout the body. Even for Chinese Americans born in the U.S. traditional Chinese medicine is well respected and may be followed alongside western medicine.
Most Chinese Americans, particularly the older generation, believe that dying at home will bring bad fortune to the family. They may also have difficulty selling their home to another Chinese person. Again the family will often make this decision together, sometimes even without the dying person offering an opinion.
If the person does die at home then the family will need to clear the stagnant or negative life energy that may be left behind. This may involve opening all the windows, removing photos of the deceased, sweeping and then washing the floor and walls thoroughly, 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.
In the home of a person who died all the 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 also the color of the unknown, purity, courage and strength.
Chinese customs dictate that before a body is placed in a casket it will be carefully washed, dusted with talcum powder, and then dressed in the dead person’s finest clothes. The clothing won’t be red because that will lead to the person becoming a ghost. A Chinese woman will often be buried with jewelry, particularly jade. A Chinese man may be buried with coins. The dead person’s face may be covered with a yellow cloth, which is the Buddhist color and represents freedom from worldly concerns. The body may be covered with a blue cloth, which represents harmony and immortality.
Symbolic paper money is often burned at a funeral to make sure the deceased will be financially taken care of in the next life. Paper money is also thrown at funerals to keep hungry ghosts away who may be attracted by the dead and can bring illness and mischief to the living.
If a wake occurs in the home of the deceased, all the mirrors will be covered, because seeing a reflection of the casket may cause a death soon in the family of the person who saw the reflection. Wreaths, photos, and gifts will be placed at the head of the casket; food will be placed in front of the casket as an offering. The person’s comb is broken, half placed in the casket to be buried with the person and the other half kept by the family. Rice may be spread around the house to lead the hungry ghosts outside away from the family.
Chinese traditionally wear white to a funeral, although today the more westernized Chinese in the U.S. will wear black. Often a piece of black material will be placed on the clothes of mourners that will be buried with the casket. After the casket is placed in the ground family will throw handfuls of dirt on top; the eldest son will keep some dirt from the grave to be used in worship ceremonies at home. Prayers will be said and family members are offered red packets with money that they must spend.
Traditionally, three days after the burial, the spirit of the person who died will visit the family. To prepare for this visit the family makes the person’s favorite food and sets it out with some of the person’s books for him or her to come and say goodbye after midnight. Annually the family must pay their respects to the deceased by making offerings and burning incense. Sometimes roast pig may be prepared and some of it brought to the cemetery as an offering to the ancestor.
Mourners are not supposed to participate in any form of entertainment for 100 days. The period of mourning depends on the relationship: three years for a child or parent, one year for a spouse.
Chinese customs will vary from one family to another depending on the religious orientation of the family members, their adherence to tradition, and the degree of assimilation to American ways of dealing with death and dying. When doing the planning work, doulas need to ask how the dying person and family want to honor their traditions and beliefs. Being aware of some of the Chinese customs will help the doula understand the family’s wishes and help them ask appropriate questions.