What Do Chinese People Believe in When the Family Membee Is Dead
Perm J. 2009 Summer; 13(iii): 55–threescore.
East Asian Attitudes toward Death— A Search for the Ways to Help E Asian Elderly Dying in Contemporary America
Sok K Lee
Sok K Lee, MD, MA, is an Allergist at the South Bay Medical Eye in Harbor Urban center, CA; Clinical Banana Professor at Harbor UCLA Medical Centre in Torrance, CA; and Master in Bioethics at Loyola Marymount Academy in Los Angeles, CA. E-mail address: gro.pk@eel.k.kos
Abstract
The fine art of dying well has been a quintessential subject of ethicoreligious matters among the people in the West and the Eastward. Most of united states of america wish to dice at home; however, nigh 50% of Americans die in acute care hospitals. Furthermore, immigrants from East Asian cultures feel more uncomfortable near death, because their physicians are not familiar with their traditions.
This article is written to help American physicians understand the unique aspects of E Asian Confucian Ideals for the meliorate care of the dying elderly. Western attitudes toward death are briefly reviewed and the vi Eastward Asian concepts related to decease are elaborated from Confucian Chinese philosophy. To widen the horizon of bioethics and to embrace the Confucian wisdom of dying well, 3 pearls of wisdom from classical Confucianism are proposed: the relational autonomy of family, Confucian artistic self-transformation, and the unity of transcendence and the human beingness.
We will have to give upwardly the notion that death is ending, or avoidable, or fifty-fifty foreign .
— Death in the Open up, Lewis Thomas
Introduction
Modern Americans die hard. We live longer cheers to new advances in modern medicine, but we die with less self-possession than our grandparents did. We meet our own expiry with fright and despair considering of anticipated pain and the helpless depression of hopelessness of any afterlife. Co-ordinate to Phillipe Aries, French historian, decease has gradually go forbidden and unnamable 1 since the second one-half of the 19th century. In her work on Death and Dying, ii well-known Swiss psychiatrist Elisabeth Kübler-Ross laments that in this post-modern a-religious and secular guild, a few of us dice in what she calls the fifth stage of acceptance. During the 1950s and 1960s, advances of medical applied science in the US transformed the healing arts into scientific medicine. As evidenced past the summer 2008 effect of The Journal of Clinical Ideals (Volume xix; Outcome No. two), which focused on end-of-life issues, recently at that place are efforts to recreate a modern version of the medieval ars morendi, or fine art of dying, which includes hospice intendance, palliative medicine, and advance directives. Notwithstanding, approximately 50% of elderly Americans however die in acute hospitals, even though well-nigh wish to die in their homes.3,4 These patients likewise die in more hurting than not, unnecessarily. With an added cultural barrier, dying E Asian immigrants in the U.s. die in religiocultural distress because of the unfamiliar American attitudes toward expiry and dying. They wish to die in their homeland.3,iv Ethics committees from effectually the country do not value their unique way of ending life as their own family would adopt, because the bioethical norms of the committee members are inculcated by the principlism proposed past Beauchamp and Childress.5
I volition briefly review Western attitudes on dying, drawn from the studies of Phillipe Aries,i Elisabeth Kuebler-Ross2 and Sandra Gilbert.6 I volition and then argue that unique features of Eastward Asian ideals can contribute to American bioethics, highlighting 3 aspects of Confucian philosophy of death and dying: ane) the relational autonomy of family, 2) Confucian artistic self-transformation to sagehood, and 3) the unity of transcendence and man beingness. These 3 pearls of dying wisdom are fatigued from six Confucian attitudes toward death along with NeoConfucianism of Chu Hsi7 up to that of a New Confucian, aTu Wei-Ming.eight
Western Attitudes Toward Death
"In the 1850s, Western society had witnessed a brutal revolution. Death, then omnipresent in the past that was familiar, would be effaced. It would become shameful and forbidden," wrote the French historian, Phillipe Aries.1p85 Beginning in the 1950s, people died away from dwelling house primarily in hospitals, receiving intensive medical intendance. Physicians, the masters of death,1p89 sanitized dying, and made information technology more "acceptable" to the survivors of the deceased. The dying person is separated from family and habitation, and is seldom aware of his/her rights on how and where to die. Physicians do not know when to pronounce death for asleep patients unless they rely on electroencephalography and its interpretation past a neurologist for brain expiry. The survivors are then expected to recover from grieving equally quickly equally possible, and whatever prolonged grief becomes a suspicious sign of depression. Expiry is forbidden and avoided equally much equally pornography, according to Geoffrey Gorer.9 This trend is more than pronounced in European countries than in the United states.10 Phillipe Aries marvels at the American funeral traditions, which seem more traditional and euphoric than its European counterparts.1 In Europe, at that place are more cremations and visiting gravesites is rare. Aries longs for the renewal of the medieval agreement of tamed death or one's ain death. This, then, evolved into thy death, which JudeoChristians comprehend in their belief that God gives us a convincing reason to accept expiry through an embrace of organized religion. Aries asks if "our technological civilization could ever regain the naïve confidence in Destiny which had for then long been shown by elementary men dying."1 His lamentation is augmented by another view illuminated past Kübler-Ross in her research in 1969 on the stages of dying and her volume, On Death and Dying.2
Elisabeth Kübler-Ross expounded on what the dying have to teach doctors, nurses, clergy, and their own family unit.two She identified 5 stages of dying: denial, anger, bargaining, depression, and acceptance and advocated for healing professionals to recognize them. She argued that we are fearful of an imagined agony at decease. Nosotros need that medical professionals delay dying as long equally possible and believe that death signifies defeat of the physician. The sustaining virtue for the patient to reach the final stage is identified as hope, likened to a metaphoric thread running through the five beads of the stages of dying. Ironically, Kübler-Ross blames fearful death on recent advances of medical technology—the source of the blessing of longer life. Forth with books such equally Callahan and Kelley's Final Gifts,10 Kübler-Ross'due south On Death and Dying has been instrumental in improving the American hospice system. Ms Callahan and Ms Kelley, hospice nurses, share insightful stories of their experiences of awareness in those who are nearing death. In that location is much to be gained from listening to the experiences of those in direct intendance of the dying.
How are we coping as a modern guild in the 21st century? In Expiry's Door,6 Sandra Gilbert explores mod dying grieving. She invites her readers to death'southward door and asks u.s.a. to peek through, to gustation and to feel the reality of death via her poetic imagination. We die lonely and isolated. The survivors' grief is curtained and silenced. As an elegist, poet, and retired English professor, Gilbert offers iv remedies of improve dying for modern Americans. She advises us to listen to and for the dying persons, to look at them as we back-trail the dying toward decease's door, to retrieve the lives of those who pass through the door, and to imagine a resurrection of the dying as a transfiguration back into this earth. Death'southward door is the door of life and it is always open to sneak a peek, and to stride in and out. It invites all who are curious.
As seen by the four principles of bioethics studied by Beauchamp and Childress,5 American bioethics for end-of-life intendance proclaims and upholds the rights and autonomy of the dying to make decisions. As shown in legal cases such every bit Bouvia v Superior Court (1986)11 and Cruzan 5 Managing director, Missouri Section of Health (1990),12 justice and beneficence are pushed behind. The right to die was legally recognized in these cases, and after some European countries made some similar legal judgments, the Expiry with Dignity constabulary (ORS 127.800-995) was passed in Oregon in 1994.
The main reason Oregonians resorted to physician-assisted suicide was to ensure that the dying person would not lose command of his/her own dying process. Plainly, the fright of death would be "overcome and controlled" by the option of suicide. We modern Americans have been offered a manner out of the sanitized and grim Western expiry experience through Kübler-Ross's hospice care and Gilbert's remedy of poetic imagination. Is there another healthy mode to approach dying, another modernistic ars moriendi, investigated "out of the box" of our Western thoughts?
Eastward Asian Attitudes toward Expiry
Chinese philosophy is likened to a concerto with three movements.thirteen The first movement is the ancient wisdom systemized by Confucius (551-479 BC), who had collected and promulgated wisdom to bring social lodge in Spring Autumn warring period. The second movement can be described equally the medieval menstruum, which predominated during the first millennium, while Taoism and Buddhism were adapted to and adopted as the "Iii Teachings of China." The last movement, lasting for the next millennium, began with Confucian logical systemization by Chu Hsi (1130-1200 AD) and connected with Neo-Confucianism, which is hallmarked by a revival led by Wang Yang-Ming (1472-1529 AD). Presently, we observe a recent new renaissance to rejuvenate 
Confucian creative self-transformation proposed by Tu Wei-Ming.8
The primary thematic assertion throughout the 3 movements is that man tin cocky-transform creatively to become a superior man (
) and a sage, while he abides perseveringly in two prime virtues; jen (humaneness, 
and li (ritual, 
) with chung (sincerity, 
). I describe from A Source Book in Chinese Philosophy by Wing-Tsit Chan7 to survey Chinese philosophy with Chinese characters then that those familiar with them will take a greater understanding of the subtleties.
Confucius (551-479 BC) was able to elaborate the possibility of human perfectibility and an idea of subjective anthropocentrism. For the next 2500 years, his teaching of jen (
and li (
) and his philosophy take spread widely to influence greatly China, Korea, Japan, and Vietnam. Mencius (371-289 BC), an idealistic Confucian sage, refined and internalized Confucian teachings by emphasizing the inner ability of the listen to practise good by cultivating the original seeds of the beginnings of 4 virtues: humaneness (
, righteousness (
), propriety (
) and wisdom (
). Presented hither are the teachings of both Confucius and Mencius relevant from the Chinese classics, Analects,7p18–48 Mencius,7p49–83 The Swell Learning7p89–94 and the Doctrine of the Mean.7p95–114
a) The Mandate of Heaven (
): Heaven is the showtime component of the Chinese "trinity" which is followed by the two other components, World and Man. Whereas the concept of earth consisted of natural phenomena such as the four seasons and wind and pelting, the idea of Heaven was transformed from the idea of the almighty devilish spirits with angry demands in prehistoric China (up to 800 BC) to the concept of the benign ancestral supporters. By the time of the Jump and Autumn era (500 BC), the importance of the savage powerful mandate became minimized, equally the Confucian humaneness of virtue was considered more important. Heaven'due south will became a kind of principle (
), moral destiny and natural endowment in about 1100 AD, when Chu Hsi—the Chinese Thomas Aquinas—systemized the Confucian philosophy with Taoism and Buddhism.
When Confucius was very ill in his quondam age and a prayer was offered past a student, he responded that "What counts is the life that one leads."7 Human beings are self-perfectible equally long as they are trying sincerely to be god-similar. This unceasing effort of human being is limited and simply perfectible through promise. Confucius taught a concept of fate and destiny, in which one is to be neither in despair, nor to be presumptive about expiry and life.
b) Confucian idea of fate and destiny: Fly-Tsit Chan7 upholds the Confucian theory of "waiting for destiny" as the best prevailing theory over other theories most destiny or the mandate of Heaven. Co-ordinate to this theory, man should exert his utmost in moral endeavor and get out whatever is beyond our control to fate. Life and death are the decree of Sky. The superior man does not complain against Sky above or blame man below.7 Confucius knew the Mandate of Sky at the age of 50.7 Withal he strived to exist at ease with whatever he heard and could follow his heart'south desire without transgressing moral principles.
c) Funeral Reaction by lamentation, emotional crying, singing, and beating on an earthen bowl: The aforementioned Confucius' lamentation to Heaven is contrasted with Chuang Tzu's (
) singing at the death of his wife. Univocal logic is simply skillful in mathematical trouble-solving. The mystical fashion of Chuang Tzu (399-295 BC, Taoist philosopher) who has expanded Lao Tzu's Taoism, needed a dialectical poetic voice to make a sense of the absurdity of dying (Chaung Tzu, the equality of life and death). In response to remonstrations for his mourning, Chuang Tzu said, "… I realized that originally she had no life; and not but no life, she had no class; non but no form, she had no fabric force… for me to go about weeping and wailing would exist to show my ignorance of destiny."7
Chinese culture recognizes Heaven, fate, and spirit, just anchors the existential perspective on family life; whereas Western culture looks to God for individual salvation. Ariesane reviewed how Christians relied on the concept of afterlife to cope with the despairing desperation of the deathbed. For the mod, Gilbert invoked "an imagined resurrection in order to embrace the mystery of death."6p433 This fundamental difference in perception of existence as deeply embedded in family every bit opposed to individualist existence is extremely important for understanding the style that Due east Asian people cope with grief in death and dying.
d) 5 Relations of Mencius: Mencius advocates that the seedlike goodness inborn in man's heart can exist cultivated to bear good fruits by persevering instruction. "Man without education becomes none but an fauna."seven The V Relations teach that at that place should be a norm of man relations past moral reciprocity with a hierarchical degree of priority; "… between father and son, there should be amore (
); between ruler and minister, there should exist righteousness (
); between husband and wife, in that location should exist attention to their split up functions (
); betwixt old and immature, in that location should exist a proper order (
); and between friends, in that location should be faithfulness (
).7 Chan points out that simply the first relation is biological and the rest are moral relationships. It is of notation that this precept of Five Relations does not include strangers and the enemy. Out of the five, the amore between begetter and son trumps over the righteousness in social relationship. When a father has stolen a sheep, his son should muffle the misconduct of his father rather than testify against his begetter.7 Even a son-rex should resign his kingship, when he discovered his father-king's past misconduct, he should run away with him and hibernate together far away, Confucius admonishes. The reason, he explains, is that the begetter-son affection should be protected at all toll. This prime utmost value of the family is crowned in East Asian ethics as the doctrine of relational autonomy of the East against that of individual autonomy and liberty of the West.
e) Eight steps of creative self-transformation of The Bully Learning (
): The Great Learning (
),seven a small-scale i-chapter classic, has exerted great influence on Chinese thought. This is a Chinese methodology to learn to be a superior human being, to cultivate an appreciating family unit, and to promote peace in the world. These eight steps, which include the investigation of things (
), extension of cognition (
) sincerity of will (
), rectification of the name (
), tillage of personal life (
) regulation of the family (
), national order (
), and world peace (
), commencement an individual creative cocky-transformation by inner investigation and sincere contemplation. He then transforms the family, his society, and the earth. In one case skilled with this method, a student of ethics could take a journeying through the Chinese dialectics of harmonization to reconcile with the fear of death.
f) Chinese dialectics of harmonization and New Confucianism of Tu Wei-Ming: To overcome the impasse of Western dialectics of contrast, Chinese wisdom offers the harmonious dialectics earlier known equally "following ii courses at the same fourth dimension," which is found in a story of a monkey keeper's ingenious reconciliation with his grumpy monkeys past just switching the feeding sequences from three-nuts-in-the-morning time-four-in-the-evening to four-basics-morning-three-evening.vii Therefore, when the sage harmonizes, the right and wrong rests in natural equalization. Chinese Doctrine of the Mean 19 emphasizes a dynamic centre embracing the opposites together on the middle in the always-changing process without forgetting the ideas of two opposites. Tu Wei-Ming's creative cocky-transformation takes its root from Confucius' admonition to exist a human of dialectical harmony:vii,8p28 ". A man of humanity, wishing to establish his own character, also establishes the character of others, and wishing to be prominent himself, also helps others to be prominent."8p132 Tu claims that persevering cocky-comeback could be possible only by helping others improve in the promise that we together will eventually exist in peace.
What are the Pertinent Aspects of Confucius Ethics to Assistance Us Care for Elderly East Asians, Sick and Sick in the US?
Three concepts of E Asian ethics, once appropriately applied to the principles of American bioethics, volition benefit East Asian elderly for a better procedure of dying.
The Relational Autonomy of Family; An Attribute of Interpersonal Relation
In dissimilarity to the political person-hood of the West, in which a Westerner considers family as a volitional choice, the familial personhood of the East stands on the foundation of a family unit with each private person. "Filial piety (
) is ane of the roots of humanity, with the other brotherly dear ."7 The continuity of a family connotes perpetuity of the self and is valued every bit a fashion to attain personal immortality in the Chinese mind. Having no children was i of the 3 vices against his parents according to Mencius.7 A son should respect and care for his crumbling parents and continue ritual sacrifices after their deaths. The individual and his or her family are closely bonded, rather than two split up entities. In dissimilarity, the generational union of Western families is melting down, perchance, because the individual right trumps over the familial correct. According to H Tristram Engelhardt, Jr,xiv Western marriage is a dear-initiated, partially economic symbiotic arrangement for bicareer cohabitation. Atomized Western man is dislocated historically: once he goes off to college declaring an independent life, he is a nuclear human without family. Individual rights and freedom, as guaranteed by the US Constitution, trump those of the family. After, the euphoric freedom of the individual somewhen becomes boredom. A life without purpose becomes meaningless. I lament that this is one of the untoward side effects of Kantian autonomy and Nietzschean nihilism.
To rescue The Western Fall of Man, Shui Cheun Lee,15 an E Asian ethicist, proposes a concept of relational autonomy that entails a two-dimensional decision-making process for end-of-life intendance. Western individualism is rejected, because it insists on, "I am, therefore y'all are." Instead, "You are, therefore I am" is the cadre of Confucian ethics. In the Doctrine of Mean vii and the dialectics of harmonization, patient and physician invite the family every bit a iii-member group for the purpose of agreeing on important clinical matters. When an Eastern human becomes sick, all family unit members are afflicted because life's value is family unit-centered in spiritual, ethical, and financial matters. A man is a being-in-between, equally promulgated by The V Relations.7 For Eastern culture, discussion of diagnosis and prognosis are oftentimes not confidential matters between the patient and dr..
Confucian Creative Self-Transformation Toward Sagehood; An Aspect of Personal Self-Perfectibility by Helping Others be Perfect
According to Confucius, the Chinese concept of immortality becomes possible and believable through virtue-building, achievement, and perseverance.vii Anyone is perfectible past the eight steps of The Keen Learning. The six stages of Confucius' life7 take been drawn to undergird the cocky-transformation of Tu Wei-Ming'due south artistic improvement of graphic symbol in New Confucianism. The creative tension built past internal Jen (humanism, 
) and external li (propriety, 
) has been a dynamic strength for a persevering person to have a journey as a pilgrim of hope toward a process of becoming an authentic man beingness, which is the Confucian Heaven. In a similar vein, a pilgrim with family undergoes a reciprocal change with tillage and transformation, equally together they accomplish sagehood. In essence, the pilgrim and gild become one, neither alone nor separated. Tu'southward 2 dialectical transformations are reminiscent of the double movements, the infinite resignation and the leap of organized religion, of Kierkegaard.16 And so, when an East Asian old human in the utmost involvement of sagehood follows the path of Confucian perfectibility of personhood, he would be able to encompass his death and dying with no fear or boredom, but rather with joy and pleasant surprise. By his age of lxx years, Confucius could follow his heart's desire without transgressing the moral principles7 and Chuang Tzu was able to sing at his wife's funeral.7
The Unity of Transcendence and Human Being; An Aspect of Confucius Religiosity
Confucius said, "How arable is the display of power of spiritual beings!"seven Nonetheless, Confucianism has not been recognized as a religion in the Westward, because information technology has no doctrine of a deity and is not affiliated with an institution. Those western thinkers often quote, to disparage the lack of religiosity in Confucianism, Confucian retorting, How tin can we know about death, if nosotros don't know yet about life.seven Only Tu asserts that Confucianism is religious considering it has faith in the ultimate goodness and across-the-board divinity of man nature, decreed by Sky to exist fully realized through the conscious and conscientious activity of the mind.viii Tu restates Confucian religiosity in terms of a twofold process: a continuous deepening of ones' subjectivity and an uninterrupted broadening of ane's sensitivity.8 The concept of Heaven has been transformed for two millennia from devilish and wild spirits to guiding norms of morality and principles of nature, equally illuminated in the before section (a). In addition, atheistic Chinese religiosity became tamed and philosophized by Neo-Confucian thinkers, accommodating Taoist's mysterious Tao and Buddhism'southward metaphysics. Due east Asian people believe that through family names and rituals they are able to proceed their spirits live symbolically. Therefore, a person is never forgotten nor dies. In contrast, Western Christianity rejects decease, believing in eternal life after expiry. Eastern philosophy is narrative, Western is belittling. The characteristics of the onetime are intuitive, applied to know how, interdependent, and corelational, whereas the latter is logical, systemic to know what and independent. The Eastern procedure is of dialectics of harmonization and cyclical in the worldview, as the Western process is of dialectics of conflict and evolutional and linear in the worldview, co-ordinate to Ames.17
Conclusion
In that location are iii aspects of East Asian ethics to assistance the elderly from Eastern asia cover their decease in better moral comfort: the relational autonomy of family, new Confucian artistic self-transformation to sagehood, and Confucian ethicoreligiosity. How tin can Western clinicians aid dying patients of East Asian culture? First, encourage, invite, and involve the patient'due south family unit in the conversation about cease-of-life care. Considering they find the pregnant of life grounded on the relational autonomy of family, East Asian elderly patients tend to exist less individualistic and hope to exist a part of the family unit. Second, E Asian cultures value a specific kind of self-comeback, which becomes perfectible with others. Asian-American patients may announced to exist stoic, self-controlled, and meditative in facing pain and death; they accept Heaven'due south mandate equally a function of natural passage. These attitudes may come up from supranaturalistic Taoism or Zen Buddhism. A physician finds that the patient ends his/her life in peace as a cycle of nature. Furthermore, by helping others improve they become self-transformed. Together, they volition eventually be whole and in peace. Such community solidarity under-girds the relational autonomy of family. Finally, East Asian atheistic means should be recognized to be equally religious equally Western theism. East Asians believe in the chivalrous spirits of ancestors, whom the living ought to keep pleased in annual rituals. Such religious thoughts provide hopeful answers to the mystery of decease for the dying. Physicians could describe Confucian religious resources for East Asian elderly to ease the existential suffering of expiry.
The difference in the roots of these two traditions should be recognized in each unique locality if we hope to maintain peace in local and global communities. Engelhardt14 proposed to recognize moral strangeness in our global village, where the moral diverseness is ane of the features of the global world. Past drawing wisdom from Confucian relational autonomy of family unit, dialectics of harmonization, and the creative cocky-transformation toward a peace under the religious Heaven, we could explore a new ethical theory to facilitate globalization without losing particularity.
Acknowledgements
The author expresses thanks to Professor Robin Wang for her guidance in his independent written report of Chinese Ideals in 2008 and to Professor James Walter for reading this manuscript and for his encouragement. They both teach at Loyola Marymount University in Los Angeles, CA.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911815/
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