焦點熱話 : 未知死 焉知生 吳有能博士訪問
We all go through the same natural lifecycle of birth, ageing, illness and death. Yet while discussions about childbirth and our everyday ailments are common, talking about life and death is by no means easy, and death remains a taboo subject in the Chinese society of Hong Kong. To ensure a graceful end of life journey, the development of life education is as important as the relevant social policies and medical services.
Every five years, The Economist Intelligence Unit conducts the Quality of Death Index Survey, which analyses the quality of hospice care services in 80 countries and cities around the world. In 2015, the United Kingdom topped the global chart, while Taiwan was ranked sixth and first in Asia, and Singapore came 12th. However, Hong Kong lagged behind the other developed countries in Asia, coming in 22nd place. The scores of certain services in Hong Kong were even lower than that of Panama and Mongolia.
Each year, more than 40,000 people die in Hong Kong. Yet despite the rapidly ageing population in the territory, the majority of Hongkongers avoid talking about death, not to mention the pursuit of a "good death", due to traditional Chinese beliefs. Hong Kong has a well-established healthcare system and its hospice care services have become more comprehensive, but an education that teaches us how to treat and face the matter of life and death is still not that common.
The evolution of life and death education
Dr William Ng, Associate Professor of the Department of Religion and Philosophy and an activist in civic life education, launched the life and death studies programme at HKBU 14 years ago. He believes that life and death education is a very broad concept, as it not only covers discussions on the meaning and value of life, but also enables people to be aware of death and learn how to face such issues. Therefore, a life education programme that avoids talking about death is not only incomplete but unrealistic as it ignores an inescapable element of our existence.
"Developed from thanatography, which refers to accounts of death in Europe and the Americas in the 19th and 20th centuries, the study of life and death was put together as a discipline by Japanese scholars after World War II," says Dr Ng. "It spread to East Asian communities, particularly those in Taiwan and Korea, and was then brought to Hong Kong in the early 1990s."
Dr Ng says that in the past medical and nursing education mainly focused on curing patients. Later, the concept and philosophy of hospice care became more widely recognised. This resulted in changing concepts and practices, and a shift from curing to caring for people with hospice needs. These days, the idea is no longer about trying every possible medical means to cure the patient, but rather to substitute it with a caring philosophy. For those at the hospice stage, the most important concern is not the restoration of their health but instead the recovery of the feeling of being loved and cared for, the avoidance or reduction of physical pain and, overall, the dignity of being a human.
Under the umbrella of "holistic healing", hospitals strengthened care for dying persons by fulfilling their physical, mental and spiritual needs and began to provide such care services as early as possible during the treatment period. Some integrated services such as palliative care, hospices and long-term care have been developed subsequently. Many services also benefit patients' families by offering a broad range of physical and mental support. In general, the overall quality and quantity of hospice care services in Hong Kong has been enhanced.
Life education in Hong Kong vs Taiwan
Despite the improvements seen in many relevant services, life and death education in the community has fallen way behind. "It is not right to think about death as something that only happens when we get old. People may die young. In fact, we need to be ready to face death anytime and anywhere. When teaching life and death education at the University, it is necessary to include matters related to death, such as the loss of a pet, abortion and suicide, instead of confining things to hospice matters," says Dr Ng.
In Chinese society, Taiwan is said to be the leader in the promotion of life and death education. Courses on life and death can be found at the undergraduate level in many universities and colleges, and there is even a graduate institute on life and death which offers university degrees up to master's level. "The Ministry of Education in Taiwan incorporated elements of life and death education into different courses in the nine-year primary and secondary education standard curriculum as early as 2000. It also introduced relevant education initiatives into class activities and various subjects. In such a way, students are able to talk about life and death through different channels from an early age," says Dr Ng.
In Hong Kong, some community hospice care organisations, such as the Comfort Care Concern Group and the Society for the Promotion of Hospice Care, have tried to promote life and death education by organising seminars and death experience activities for the general public in recent years, enabling the elderly to learn how to face the issues associated with death.
In addition, certain non-profit organisations offer life and death education programmes to encourage Hongkongers to break the taboo and get to know the meaning of death, and to promote hospice care and bereavement care services. Some tertiary institutions also offer liberal education programmes on life and death. Nevertheless, Hong Kong has hitherto been lacking in systematic death education policies.
Lack of appropriate education policies
Dr Ng says only a few schools probe into life and death education through religious or ethical studies as far as the education framework is concerned. But even then, the content and methodologies have to be explored and developed individually. "Instead of volatile schemes, a systematic approach is necessary for planning life and death education programmes. The gravest issue for Hong Kong is being short of long-term education planning," he says. Besides, the Government does not provide any specific curriculum guidance on life and death education for either primary or secondary schools, not to mention funding support.
Instructor training also poses a great challenge. Dr Ng says that talking about life and death in schools is not merely about conveying simple concepts to students. Generally speaking, it includes three interrelated aspects: the cognitive aspect that includes theory and knowledge, the affective aspect that deals with emotion, and the practical aspect that talks about relevant skills. The death of someone can be hugely traumatic, and instructors need to have sufficient training and emotional healing techniques to teach students how to deal with death and cope with feelings of grief and loss.
Equally, instructors cannot solely rely on self-exploration when it comes to guiding students to ponder the value of life through the discussion of death. Therefore, instructor training needs to be supported by long-standing and systematic policies on life and death education.
Understanding the meaning of life from childhood
As Confucius famously said, "If we don't know life, how can we know death?" The essence of education is to equip ourselves with the knowledge and skills to tackle different challenges throughout our lifetime. Therefore, Dr Ng believes that it would be better for people to receive life and death education as early as possible. "I don't think age should prevent children from facing the issue of death. Even the death of a pet is a loss to them. Teachers and parents, with carefully chosen topics and good teaching skills, may as well help kids encounter these issues when they're young, as they can establish positive thoughts and values, and help them understand and accept life and death. Only in such a way will children know how to appreciate and cherish what they possess, and learn the meaning of life."