1. Li Fang still remembers the anger and incomprehension she faced when she suggested stopping treatment for her dying father in 2023. The 80-year-old former doctor had suffered a cerebral infarction for years and his bodily functions deteriorated after an acute appendicitis attack, leading a hospital in Qiqihar, Heilongjiang province, to issue a final notice. Li had previously agreed with her father that he did not want excessive treatment, but her mother and aunt insisted on intubation. The hospital offered no palliative care, and emergency treatment prolonged his life by three months of visible struggle, such as when a nasal tube was fed through him. Her experience captures a dilemma confronting an aging China: how to reconcile palliative care with the deeply rooted belief that continuing treatment is a family's duty. [para. 1][para. 2][para. 3][para. 5][para. 6]
2. China's population is aging rapidly, while chronic diseases account for more than 88% of deaths, and the country recorded about 11.31 million deaths in 2025. Yet palliative care remains a small part of the healthcare system, with more than 4,000 medical institutions having such departments, accounting for less than 0.4% of institutions nationwide. China began experimenting with palliative care in the 1980s, but nationwide development accelerated only after pilot programs launched in 2017, with three rolled out by 2023. The 15th Five-Year Plan, running through 2030, calls for increasing supply of rehabilitation and palliative care, but building the necessary links requires trained doctors, nurses, social workers, volunteers, payment mechanisms and, perhaps most fundamentally, a change in attitudes toward death. [para. 8][para. 9][para. 10][para. 11][para. 12]
3. Doctors highlight the persistent cultural barrier. At Beijing Tsinghua Changgung Hospital, palliative care director Lu Guijun describes it as a "step-by-step struggle for survival," noting families seek another hospital or treatment even when a disease is terminal. Cao Feng, at Beijing Geriatric Hospital, recalls patients' families demanding CPR even after the electrocardiogram was flat. Palliative care, doctors emphasize, does not mean abandoning patients; it changes treatment's purpose from prolonging life at any cost to controlling symptoms and allowing dignified remaining time. This became clear for Zhang Yang, who had battled liver cancer for two decades, was told he had one to two months to live, and found great relief after receiving palliative care at a community health center in Beijing, which controlled his seizures, eased his coughing, and improved his mood and appetite. [para. 13][para. 14][para. 15][para. 16][para. 17][para. 19][para. 20]
4. Beyond medical care, institutions like Tsinghua Changgung combine doctors, nurses, social workers and volunteers to address physical and emotional needs, even moving a wedding into the ward to fulfill a patient's wish. Haidian Hospital trains volunteers on tasks like hair washing and maintaining boundaries. For Lulu, whose mother received palliative care there, small acts like hair washing and pain management brought the most comfort in her final week; her mother, wanting to leave the world "cleanly and with dignity," died peacefully without intubation or invasive resuscitation. However, Lulu's suppressed fear and grief emerged after her mother's death, and support came from hospital social workers, music therapy, and a grief-support group, eventually leading Lulu to return as a volunteer. [para. 23][para. 24][para. 25][para. 26][para. 27][para. 28][para. 29]
5. Scaling such support is difficult because China lacks enough trained personnel. Palliative care is not yet an independent medical discipline, and Cao Feng says some departments face succession problems as leaders approach retirement, with younger doctors reluctant to enter due to limited promotion opportunities. Medical social workers are even scarcer—according to Zhang Lei, only a few dozen in Beijing specialize in palliative care. The problems are acute outside major hospitals, where ideal models rely on community health centers and home-based services, but community facilities often lack expertise for rapidly changing terminal conditions. Beijing's Xiaohongmen Community Health Service Center has a 30-bed ward staffed by general practitioners with specialized training, yet sees few complex cases, and home-based care lacks manpower. Some networks are emerging, such as in Beijing's Chaoyang district, where a specialist alliance led by Tsinghua Changgung connects more than 30 institutions. [para. 31][para. 32][para. 33][para. 34][para. 35][para. 36][para. 37][para. 38]
6. Payment is another unresolved problem. Beijing added palliative care to the Class A medical-insurance reimbursement list this year, with a unified fee of 200 yuan ($30) per day, but providers say this is often insufficient. At Beijing Geriatric Hospital, Cao calculated that the doctor's consultation, level 1 nursing, and assessment fees alone total 206 yuan per day, excluding psychological and humanitarian care. Additionally, palliative care does not fit neatly into existing payment systems like Diagnosis-Related Groups, which pay hospitals predetermined amounts by disease category, making resource-intensive end-of-life care financially difficult. The government is gradually addressing these gaps, but doctors and researchers agree a broader change in how death is understood is essential. As Lu Guijun asks his team, how they would like to spend their last days, stating: "Hospice care is not about giving up treatment... the core concept is that death is possible at any time, but life is something we must strive for every step of the way." Li Fang, Zhang Yang, and Lulu are pseudonyms. [para. 39][para. 40][para. 41][para. 42][para. 43][para. 44][para. 45][para. 46][para. 47]
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