Cancer International Health Care Systems

End of life care in China

An interesting article from Longreads on dealing with a grandmother’s terminal illness in China.

Guo Zhen didn’t know she had cancer, and my family had carefully devised a strategy to keep it that way. Doctors and nurses in the hospital had been instructed to never speak of her illness in her presence, and visitors to our home signed an invisible contract before entering, agreeing to act as if her recent hospitalization was due to a case of pneumonia. I never asked her to sit down when she’d get up after every few bites during lunch or dinner to restock the table with congee, buns, or pickles — I knew she did this out of habit rather than necessity. Fu Yuan and his wife never fought to take over her housework, though we worried about the strain of repetitive hunching on her weakening body. Any deviation from routine risked puncturing the facade of normalcy we all worked carefully to preserve, and, within a month, my family had become a theater troupe improvising their first performance, an intimate Truman Show designed to deceive its protagonist. At 78, there was no point in performing surgery or chemotherapy on Guo Zhen anymore, and any new miracle drug that might land in the world would only arrive in China years after its introduction on the American market.

The interesting part is not that a single family hid the illness their elderly family member, but rather that this is a not uncommon practice in China, one to which clinicians are completely accustomed.

…lying to ailing patients remains a common practice in China, despite an increasingly individualistic society. The hospital’s nurses had rehearsed similar consolations many times over, telling aging grandmothers and curious children that they had nothing more than the flu. Doctors used a well-worn thesaurus of medical exonerations: They’d look at her charts, ask her a few questions, and conclude with, “a yi” — auntie — “be careful not to catch another cold.” When Guo Zhen arrived at the oncology department to receive radiation treatment, the sign announcing the ward had been taped over. Instead, new characters now described it as the “general treatment room.”

Further, while in the U.S. providers typically rely on patient input over care decisions with some (sometimes a little, sometimes a lot) input from family members and caregivers, in China, money talks.

…in the country’s painfully commercial health-care system, it was those who footed the bill — or whichever kids or family members who pooled together their savings — who got the last say.

Very interesting throughout.

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