As a clinician who has worked in a third-class first-class hospital, he should be able to see all kinds of dying patients in the emergency room, some of them are sudden injuries, such as brain trauma caused by car accidents, some are sudden and severe, such as acute large-scale anxiety infarction, but more are patients with terminal chronic diseases, such as middle and late malignant tumors and late pulmonary heart disease. In these medical behaviors or hospice care, patients, family members and doctors often appear at a loss and are not fully prepared physically and mentally. To some extent, this should be closely related to the serious lack of death education in Chinese mainland.
From a medical point of view, a large part of the medical resources occupied by a person in his life will be consumed in the last few months. In the last few months, patients often suffer from great fear of death, great pain caused by terminal illness and medical actions such as chemotherapy, examination and rescue, but rarely get effective spiritual comfort and support. As family members of patients, how to communicate with patients, how to accept the reality of losing their loved ones, how to choose between continuing and giving up, and how to bear psychological and economic pressure are all at a loss. Even doctors who have received professional education obviously lack systematic training in how to give support to dying patients and their families, especially in psychological support. Most of their experience comes from their own clinical work, which is neither systematic nor necessarily effective. And for terminally ill patients, drug support alone is really not enough. Because patients, family members and doctors don't know enough about hospice care, they often give up, don't treat, and sometimes overtreatment, but as a result, the pain of patients and family members has not been well alleviated, and doctors are often bound by it and can't exercise medical behavior well.
To solve this contradiction, we should not only start from the last few months, but also do a good job in death education. A person's life is only one hundred years old, and death is inevitable. A person has been facing death since birth, so death education should run through his life. But at present, what we can feel is that people in society are always secretive about "death", especially the death of living relatives, especially on holidays. They always think that death should not be talked about, and even if they want to talk about it, they don't know what to talk about. What does death mean, what will it bring and what will it take away? What should we do to prepare for death, and where should we look for the psychological sustenance of death?
There was a saying of "soul" in ancient China. After death, the "soul", that is, the human spirit, is separated from the "spirit", that is, the human body. This is death. In ancient times, various religions may have played the role of death education, telling people that death may be the appearance of immortals or the six divisions in the wheel of karma. After death, they may go to a better place and live a blissful life, or they may go to a place to pay for their sins in this life. Living relatives can also get in touch with the dead through sacrifice, prayer and crossing over. People in Tibetan Buddhism areas in Tibet believe that people are constantly reincarnation, and they are all six divisions in the wheel of karma with Buddhism, gods, demons and animals. Death is just a process of re-entering samsara. Through death, the practice of this life can be summarized once, and perhaps you can become a Buddha, jump out of reincarnation and live a blissful life. Therefore, they have no fear of death and do not avoid it. Some funeral customs that seem incredible to us, such as celestial burial, are just a way to another world in their hearts. Although we can't and won't promote Tibetan Buddhism's view of death nationwide, we can see that religion has its unique advantages in death education. However, in today's Han living areas, the influence of religion is far from enough to regulate people's view of death. Most people only burn incense and worship Buddha, but they can't understand the concept of death in Buddhism, Taoism or Christianity. This may be related to the strong pragmatism of our religion and the long-term fracture of religion. People born after liberation are unlikely to grow up in a religious environment, but now they are dying or dying. Even those who believe in Buddhism or Taoism are mostly monks. Religion is likely to be used as a way to pray for blessings, so it is necessary to use religion to adjust their outlook on life and world, thus affecting their views on death. Since the reform and opening up, although the Taoist temples in Buddhist temples are full of incense, from schools to temples, who will say how to explain death with religion? Besides, religion is supposed to be freely chosen by people, and whether it is in line with China's national conditions to make extensive use of religion for death education remains to be discussed.
There is also a view of death that deserves our admiration and study. Recalling the revolutionary martyrs, Dong Cunrui and Huang Jiguang showed fearless spirit in the face of death, and faced death bravely. Why do they do this? Should stem from their understanding of the meaning of life. They dedicated their lives to the people's cause, and death became the last dedication to the people's cause. With this belief, facing death, fear and helplessness become easy to overcome. Of course, in today's society, values are becoming more and more diversified, and it is unrealistic to ask everyone to die. But understanding the meaning of life is very important for people to face death well. The meaning of life should be a controversial topic, but I should be a part of death education. Schools, families and society should provide such conditions and atmosphere for people to think about whether the meaning of my life is life, even if it is Buddhist or Taoist practice, it will be of great help to a person to face death well. In other words, we should not keep silent about death out of taboos or other considerations. We should discuss the meaning of life and death from an early age and integrate death education into primary and secondary education. Many schools in Europe and America carry out similar death education, so that children can think ahead about what they should do and help their loved ones. Only by thinking and preparing for death for a long time can people stay calm when they really face the death of themselves or their loved ones. Only through long-term thinking and preparation can people gradually establish a correct understanding of death.
In addition, the reasons for people's confused understanding of hospice care at present should also include the continuous improvement of people's living standards in the past 20 years and the redistribution of medical resources in the process of socialization. In other words, different people are treated differently in the face of death, and they don't want to be compared, at least they don't want to fall behind. Before the reform and opening up, people lived almost the same life with the same salary, and the treatment of seeing a doctor was roughly the same. They held a memorial service when they died, which was a fire after death. Perhaps the biggest difference in facing death is eulogy, but it has something to do with what they have done before, so death will not be so tangled. But now that an old man has passed away, his children will inevitably be entangled in the thoughts of other children. If they give up, will they be called unfilial by others, or will they involve inheritance and other issues? Similarly, when the husband dies, the wife should consider the man's family; When the wife dies, the husband should consider her family. As a doctor, perhaps because of fear of recurrence of family members after the death of patients, doctors and family members of patients always have various conversations. As the family members of patients, perhaps it is to reduce the pain of patients, or because of taboos, I feel that I should not discuss death with patients, and most family members of patients do not discuss their own illness and death. As a dying patient, he is often not the last person to make a decision, and doctors are also entangled in many entanglements. Sometimes a patient who should have given up can live for several days or even longer with the help of life support system. Isn't this indifference and disrespect for life? Imagine what it's like for a dying patient to watch everyone around him talk about his death, not himself. To solve this problem, on the one hand, we should emphasize the fairness of medical care. Everyone should face dying people, and their medical care should be based on professional considerations. Doctors should provide suitable choices for patients and their families according to the actual situation of patients, rather than blindly following the opinions of patients' families. On the other hand, people should realize that in the face of dying patients, their own ideas and opinions should be respected more. Communicating with them earlier and longer, including death itself, can help them face death better, which is also a respect for patients. Of course, the formation of this social identity should not wait until the patient has entered the hospital, but also find a solution in long-term death education. The History, Present Situation and Prospect of Hospice Care, by Chen Zheng, was published in the 23rd issue of Hospice Care News.