There is no easy way to say goodbye.

Do I tell my loved one they are dying? How will they react to the news? Am I actually making things worse? 

A Family’s Secret

The movie, “The Farewell”, follows a Chinese family learning of their grandmother’s terminal illness, and deciding to hide it from her. Billi and her family expedited her cousin’s matrimony in their grandmother’s hometown, Changchun, China to bring the entire family together to bid a final farewell. “Based on an actual lie”, Billi is a fictionalised character of the director of the movie, Lulu Wang. As someone who grew up in Western culture, Wang shares her personal experience of struggling to keep her own grandmother’s diagnosis a secret from her. Her family, however, feels that it was the right thing to do, worried that the elderly might not handle the news well.  

Is Autonomy Not For Everyone?

Despite autonomy being an ethical part of the medical practice, many Chinese medical professionals disclose essential information to the families of the patient first and leave it up to them to decide if they want to tell the patient. According to a study conducted by the Iranian Journal of Public Health, 98% of doctors prefer to inform the family members first about the cancer diagnosis rather than the patient. Additionally, 82% of those doctors would respect the family’s wishes to keep the diagnosis a secret from the patient. Even in Singapore, such requests are not uncommon. 

East Side, Best Side?

The contrast in perspectives on disclosing health information to dying loved ones stems from cultural differences between Western and Eastern values. To quote from Billi’s mother:

 Chinese people have a saying: when people get cancer, they die. But it’s not the cancer that kills them, it’s the fear.

Some families may be worried that their loved one may react negatively to the news of their diagnosis, and affect their outlook on life. The idea of potentially causing more harm than good resulted in many families choosing to bear the burden of this information on their own. Such beliefs and ideologies are said to come from the Confucianism philosophy.

Teachings of Confucius

Confucianism is a traditional Chinese teaching that imparts knowledge and wisdom of personal ethics and morals. It is being taught that the family model is one unit and it is essential to bear the emotional burdens of loved ones. According to a study conducted by Psycho-Oncology, physicians in Western countries tend to prioritise the patient’s right to informed consent and autonomy by discussing diagnosis with them immediately. However, in Eastern countries such as China, Singapore, and Japan, doctors often adopt a family-centred approach to cancer diagnosis and prognosis disclosure. This approach involves the patient’s family deciding what information should be told to the patient.

Ethics and Dilemmas

In the medical field, “truth-telling” refers to openly and honestly sharing one’s diagnosis and prognosis, even if that may affect the patient’s well-being and capability to make rational decisions. Without informed consent, it robs patients of the chance to have autonomy and make important personal choices and decisions for themselves; some patients may feel that they have no control or say in what happens in their life thereafter, or do the things they wish to do.

At the opposite extreme, some terminally ill patients make an effort to hide their own diagnosis from the people close to them, afraid of worrying and causing distress to loved ones. By doing so, they may deny their loved ones the opportunity to grieve and offer each other emotional support during their final moments together. With debates and discussions on who should bear the emotional toll in these situations, cultural habits and traditional teachings are hard to change and such practices may continue in the near future.

Living Funerals

The idea and practice of living funerals are largely popular in Western states, as people view them as a celebration of life and a final farewell with friends and family. Living funerals are pre-funeral or memorial services that are organised when the person is still living. They provide loved ones with an opportunity to say their goodbyes, show appreciation for one another and begin their healing journey. Living funerals are more than just closure; they can be personalised to suit the individual’s unique personality, with music and food they enjoy, sharing fond memories and reflecting on the life they have lived. Read more about living funerals in our article here.

Hospice Care in Singapore

Hospice care is a specialised form of palliative care that focuses on patients that are in their last stage of diagnosis. Hospice care providers offer medical, psychological and spiritual support as they approach the end of life. For anyone unfamiliar or families deciding to choose hospice or palliative care, they may come across as daunting and overwhelming.

One hospice care centre in Singapore, Oasis@Outram is breaking stereotypes of what hospice and palliative care look like, with amenities such as an in-house bar, a greenhouse room, and even a spa. 

Image taken from Unsplash

Image taken from The Straits Times

Such facilities and services empower and create a new purpose and meaning for those who are approaching end-of-life. Reinventing and changing the perspective on approaching death, allows individuals to explore alternative ways of dealing with the process. It can provide them with newfound strength and a sense of control, making informed decisions about their care and how they want to spend their time. It motivates  personal growth and forging deeper connections with those close to them. In recent years, people are also more open to pre-funeral planning and even organising living funerals for themselves.

There is beauty in the struggle.

The truth hurts, but sometimes it could be better than the alternative. It is never easy to be honest but choosing to communicate and be vulnerable can help make conversations on difficult topics safe and comfortable.

Have you ever experienced something like this before? Share with us your thoughts in the comments below. Thank you and we appreciate you taking the time to read this article.