Palliative care

In recent years, he has also noticed a shift. Younger generations, he said, are increasingly willing to engage with death more directly — through lectures, exhibitions and even conversations about end-of-life planning strategies.

Still, these discussions remain limited. Practices like advance care planning or living wills are not yet widespread. Many people, he observes, only begin to think about such matters when confronted with serious illness or old age.

"What we lack," he said, "is not only systems, but a broader understanding of what a 'good death' means."

Is it freedom from pain? The absence of financial burdens? The presence of family? A sense of closure? The answers vary.

"I've seen too many endings in which people pretend death is something distant," said Lu Guijun, chief physician and director of the department of palliative care and pain management at Beijing Tsinghua Changgung Hospital.

At the hospital, death is not an abstract idea. It is a daily reality — measured in breath, in pain and in conversations that cannot be postponed.

Since 2019, his team has cared for around 1,000 patients, most of them in the final stages of cancer or chronic illness. The goal is not to prolong life at any cost, but to make the final stage as calm, dignified and meaningful as possible.

"This is the most important part of medicine because everyone will come here eventually," he said.

In China, that moment carries enormous weight.

"As the population ages, palliative care is no longer a marginal issue. It is becoming a central social concern," he said.

Yet, the system is still catching up.

One of the biggest barriers is silence, he said, adding: "People don't talk about death. Families often hide the diagnosis from the patient."

In doing so, they hope to protect loved ones from fear. But the result is often the opposite — patients lose the chance to make their own decisions, to say proper goodbyes, and to prepare for the great unknown.

This silence extends beyond hospitals. In daily life, death is rarely discussed openly. In media and education, it is often portrayed as something frightening or distant. As a result, many people grow up without ever learning how to face it when it inevitably arrives.

Even so, the need is real.

For doctors like Lu, working in this field changes not only patients' final days, but also their own understanding of life.

"I used to think medicine was about curing. Now, I think it's also about how to help people leave well," Lu said.

He described a simple framework for a "good death". A person should be prepared for the end, maintain dignity, and have their physical and emotional needs respected.

"It's not about giving up. It's about choosing what matters," the doctor said.

In the end, what stays with Lu are not the medical details, but the human moments.

"Fear of death is natural," said Liu Yin, director of the palliative care department at Beijing Royal Integrative Medicine Hospital.

"But what people are really afraid of is pain, loss and unfinished business. Most Chinese people don't consider these issues, because when life is going well, no one thinks about death. Few ever reflect that we are born moving toward death, and that one day, death is inevitable," Liu said.

Her work, she believes, is not to remove that fear — but to make space for it, and to help people meet it with less suffering, and more clarity. Because, as she puts it: "Death is not the opposite of life. It is part of it."

chennan@chinadaily.com.cn