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WHERE THERE IS HOPE, THERE IS LIFE: CHINESE AND WESTERN PERSPECTIVES ON LIVING THROUGH TERMINAL ILLNESS IN CHINA A Dissertation presented to the Faculty of the Claremont School of Theology In Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy By Philip Hung-wong Chiu May 2010 Acknowledgment is made for permission to include the following resources in this dissertation: Excerpts from the writings of Dr. Paul Wong on the Six Pillars of Chinese Cultural Beliefs and on Chinese virtues and worldview. Excerpts from Man's Search for Meaning by Viktor E. Frankl. Copyright © 1959,1962,1984, 1992 by Viktor E. Frankl. Reprinted by permission of Beacon Press, Boston. Excerpts from The Death of God and the Meaning of Life by Julian Young, © 2003 by Routledge. Used by permission. Excerpts from pages 14 and 123 of China's Urban Health Care Reform: From State Protection of Individual Responsibility, by Chak-kie Wong, Vai Io Lo, and Kwong-leung Tang, © 2006 by Lexington Books. Used by permission. Excerpts from "Confucian Values of Life and Death and Euthanasia," originally published in International Journal of Chinese and Comparative Philosophy of Medicine, vol. 1, February 1998. Used by permission. Excerpts from "Where There Is Hope, There is Life: Toward a Biology of Hope" by Robert L. Richardson in Journal of Pastoral Care, vol. 54, no. 1, Spring 2000. Used by permission. Extract from Health Care Transition in Urban China, edited by Gerald Bloom and Sheng-lan Tang, © 2004 by Ashgate. Used by permission. ©2010 Philip Hung-wong Chiu ALL RIGHTS RESERVED CLAREMONT SCHOOL OF THEOLOGY This Dissertation, written by Philip Hung-wong Chiu under the direction of his Faculty Committee and approved by its members, has been presented to and accepted by the Faculty of Claremont School of Theology in partial fulfillment of the requirements for the degree of Doctor of Philosophy Faculty Committee: Kathleen J. Greider, Chairperson Ellen Ott Marshall K. Samuel Lee Dean of Faculty: Susan L. Nelson May 2010 ABSTRACT WHERE THERE IS HOPE, THERE IS LIFE: CHINESE AND WESTERN PERSPECTIVES ON LIVING THROUGH TERMINAL ILLNESS IN CHINA By Philip Hung-wong Chiu What is it that prompts the tormented terminally ill to choose life, instead of killing themselves? The thesis here presented is that hope can provide them a positive attitude to remain engaged in life. Many of the peasants and "urban poor" in China are in a dilemma when afflicted with a terminal illness: on the one hand, they can ill afford even pain relief; and on the other, their requests for Physician Assisted Suicide cannot be honored because it is still illegal in China. Interdisciplinary literature review suggests that hope appears to be uniquely suited to deal with the existential concerns of these people. Field work in Southern China also lends support to the thesis. Chapter One outlines the challenges of providing health care in China. Using interviews conducted by the author, Chapter Two describes some of the ways people live through terminal illness in China, and how they manage to find meaning and hope in their cultural beliefs, strengths and values. Chapter Three explores, from the perspective of the Western philosophical tradition, the question that some of these interviewees are asking: What is my meaning of life? This brings into discussion the views of both the "True world" and "Continental" philosophers. An interdisciplinary discussion of hope (Chapter Four) suggests that four dimensions of hope, the first virtue in life followed by will, may be uniquely equipped in addressing the needs of the terminally ill. Chapter Five examines the question "Is Fostering Hope Justified in the Terminally III? " ethically, existentially, and scientifically. Chapter Six outlines different ways as to how hopefulness can be fostered by caregivers, with due respect given to the unique cultural setting of the afflicted. In conclusion, it appears that when the terminally ill have hope, they remain engaged in life, making Physician Assisted Suicide less of an issue. It should be noted that the author's social location as a Southern Baptist minister, an endorsed chaplain, and a retired physician trained in Western medicine may have lent predispositions and biases to the interpretation of literature and research interviews. Table of Contents Page Introduction vii Chapter 1. Health Care in China Overview 1 Economic and Social Change 2 Demographic Change 5 Medical Need among the Elderly 6 China's Strategy in Managing Transition 7 Evolution of Health Care in China The Period Between 1949 and 1965 10 The Period of the Great Cultural Revolution 1965 - 1978 13 Problems of the Traditional Health Care System 15 Health Care Reform (from 1980s) 17 Emergence of Basic Health Insurance (urban) 18 Reform in Cooperative Health Care (rural) 21 Current Management of Health Care Fiscal Decentralization 24 Financial Responsibility System 25 Government's Price Reform 27 Evaluation of Health Care Reform since 1978 28 ii Overall functioning of China's health care delivery system 28 Disparities between China's Rural and Urban Areas 29 Equity in Accessing China's Health Care 31 Summary 33 2. Living Through Terminal Illness in China 37 Chinese Perspectives on Suffering 41 Chinese Cultural Beliefs 46 Uncontrollability 46 Ubiquity of Change 47 Fatalism 48 Dualism 48 Collectivism 49 Utility of Efforts 50 Strengths and Virtues in Coping 50 Chinese Perspectives on Life and Meaning of Life 55 Chinese Perspectives on "Good Death" 59 3. Western Philosophical Perspectives on Meaning of Life 69 True-World Philosophy 72 Continental Philosophy 83 Quality of Life 91 Search for Existential Meaning 93 Critique and Discussion 98 Implications for the Terminally 111 101 iii 4. Hope 107 What is Hope? 109 The Earliest Virtue Ill Development 116 Chinese Perspectives on Hope 118 Western Perspectives on Hope 123 Dimensions of Hope 123 Christian Theology of Hope 129 Grounding in Scripture 129 Contemporary Theology of Hope 134 Critique 136 Pastoral Theology of Hope 140 Summary and Discussion 145 5. Is Fostering Hope Justified in the Terminally 111? Ethical Consideration 147 Existential Consideration 152 Meaninglessness and Hopefulness 153 Isolation and Hopefulness 156 Groundlessness and Hopefulness 164 Death and Hopefulness 170 Research Consideration 174 Biology of Hope 178 6. Fostering Hope in the Terminally 111 182 iv General Considerations 182 Cultural Considerations 194 Role of Physicians 198 Role of Hospice Programs 199 Role of Pastoral Caregivers 201 Where there is Hope, there is Life 203 Appendix: Interview Data 208 Bibliography 235 v Acknowledgments The author wishes to acknowledge the expertise provided by Professor Kathleen Greider, Professor Ellen Marshall, Professor Samuel Lee, and Elaine Walker (Librarian) from Claremont School of Theology (CST) in the preparation of these manuscripts. In addition, without the scholarships provided by Professor William Clements and the Chinese Baptist Church of Orange County, this dissertation would not have been possible. Throughout these many years of study, my wife Rosangela has stood by my side, providing every possible help that I need. To all these wonderful people I express my sincere thanks. vi