A Comparative Study On The Hospice Care Between U.K. And China

The concept of "hospice" is derived from humanitarian care for the elderly, the physically weak or the terminally ill. It has a long history in the West and China. Traditional hospice is mainly organized and operated by government or churches and other charities, whose major responsibility was to rescue and help the old, the feeble, the poor or the helpless. Their medical function was not highlighted until modern times.The concept of "modern hospice" was formed in the20th century to stress people’s right to choose "good death". Its aim is to perform all-round physical, psychological and spiritual concern and care for the dying or the terminally ill, and to provide psychological comfort and bereavement care to the families of the patients. In the1960s, Dr. Cicely Sanders founded St. Christopher’s Hospice in London, which marks the rise of the modern hospice movement. Afterwards, more than60countries and regions, including the United States, France, Canada, Hong Kong and Taiwan, followed the example and have been carrying out this cause one after another. Up to now, with the emergence and development of hospice movement in ever-increasing numbers of countries and regions, hospice has become a new field of scientific research and has gradually developed into a new interdisciplinary program, taking physiological and psychological characteristics of the terminally ill as the main object of study. It is designed to secure a good quality of life for the terminally ill, no longer destined to prolong the patient’s survival time as the primary goal of care.The basic target of hospice is to provide comprehensive care for the terminally ill and their families, specifically, to alleviate or eliminate the patient’s pain and other symptoms, reduce the patient’s psychological stress and anxiety in the face of death, and to provide psychological comfort and spiritual support. Moreover, it has also included the patient’s family as part of the object of care, to provide grief soothe and bereavement services, to help get rid of the psychological stress, soon as possible, brought about by the illness and consequent death of their beloved ones. The definition and determination of the service object exhibits obvious differences from those of traditional medicine. It is not based on the type of diseases---patients are not categorized according to the physiological characteristics such as the type of diseases, the specific organs affected by the disease, or other biological features of patients, like age or gender. Instead, it is defined by the trend and progress of the disease in relation to the patient’s time of survival. As a result,"the terminally ill" refers to those whose disease has no cure under the present context of medical development; furthermore, the condition of the patient is continue deteriorating or worsening, and his expected survival time is no longer than6months. The study and research on hospice care involves physical, psychological and spiritual care and concern for both the patient and his family members. It covers a wide range of disciplines and fields---clinical medicine, nursing, psychology, sociology, ethics and religion. It is, in this sense, a typical interdisciplinary course. According to the specific methods employed in the care and the categories of care, hospice care can be further subdivided into "palliative medicine","palliative care","palliative psychology","palliative sociology" and other relevant branches. Hospice care, therefore, is not simply a medical or nursing service; instead, it is comprehensive as to include counseling and consulting, philosophy of life and death, death education, health education, spiritual and social support, and bereavement care, to reflect the highly specialized and generally unified health care services.In terms of chronological evolution, hospice has gone through three stages:early sanctuary or church hospital, the rise of modern hospice---its establishment and early development, and the reconciliation between hospice care and national health insurance system. With a history of half a century, both the practice in and the research on hospice care have made important progresses. Different countries have carried out various service modes and have had varied organizations, according to their specific situations of hospice care. Generally, the most common types include the following three:independent hospice (hospital), hospice wards affiliated to comprehensive hospital or other medical institutions, and home hospice care services such as domestic sickbeds or day care. On a world scale, while the concept of hospice care, inclusion criteria and service evaluation are judged with internationally accepted and acknowledged standards, the localization of hospice service mode is significant for attention. For example, in the Great Britain, hospice service is carried out mainly as part of inpatient services, specifically hospitalization and day care. In the U.S., however, a home-based hospice care is given priority and prefered, while inpatient service is not that well-received. In comparison, hospice care in China is mostly provided in comprehensive hospitals, or specially established wards in specialized hospitals or care centers. Independent hospice is pretty sparse. Generally, speaking, several factors determine the level, quality of hospice care in any given country or region, namely, economic development, cultural heritage and tradition, moral codes and customs, and medical and heath care system, etc. The overall development in advanced Western countries is generally technically superior to, better equipped and more widely inclusive than that in third-world countries.Great Britain is the birthplace of modern hospice. It has been a model in respect to the long history of and rich experience in hospice care. British hospice is characteristic of large number, wide coverage, advanced technology, admirable professionalism and common participation on part of ordinary people. The hospice care has been in operaiton in a malignant cycle. More importantly, British development exemplifies a good combination of hospice and health care system, which has solved the problem of expenditure. In a word, hospice in such countries as Great Britain has been in efficient operation as an indispensable part of national medical and health care system, to secure good quality of existence, satisfactory nursing before death and a death with dignity.In comparison, China is now in dilemma in regard to the development of its hospice care. On one hand, traditional Chinese culture considers "being terminally ill" or "incurably ill", or "death" as a taboo. Hospice, as closely related to "death" can not be easily accepted by people. In addition, medical authorities have yet attached attention and importance to this cause, and are thus reluctant to provide funds to promote the development. As a result, hospice care in China is still at a lower level, and the existent hospices are now operating on a smaller scale, in smaller quantity and with more financial pressures, without any scientific evaluation system or consistent technical standards. On the other hand, around1.5million people die of cancer every year, over60%of whom have to suffer from pain in their terminal stages. However, it is estimated the number of people who could have some access to certain type of hospice care is only around20,000. Most of the terminally ill are still undergoing all kinds of examinations and therapies, only to prolong the sufferings of the patients, worsen the financial burden to the family and to waste the comparatively scarce medical resources. The sharp contrast between the two just highlights the poorer "death quality" of Chinese people, which cannot conform to the economic development of the country and exemplifies a violation against people’s pursuit for a life of high quality. In addition, more factors will determine a big market potential for hospice care, for instance, the ever accelerating aging of Chinese population, and the increasing number of elderly people who are now living by themselves without the company of their children. Predictably. Chinese people will have an ever increasing demand for hospice service.Hospice is fundamental to concern almost every member in the society."Terminally ill" is an unavoidable stage to be experienced by every member of a society, and the issue is thus consequently important. This research is carried out in the light of the importance of hospice. It is designed to provide a comprehensive review of Chinese hospice, to highlight its problems and challenges in a comparative perspective, and then to tentatively explore more suitable passways on the basis of Chinese history and reality. The author is expecting to provde some alternative view and useful information for decision-makers and service providers, to further promote the development of China’s hospice. The basic methodology employed in the study is comparison, with Great Britain, the cradle of modern hospice, as reference, with an aim to provide a wider view in which the level and status of Chinese hospice can be understood. Shortages can be clarified when in comparison, and specific problems can also be explored. Methodology of the study includes readings, classifications and analyses of documents and literature, questionnaire, investigation and interviews. The contents of comparison involve the origin, background, objects of service, contents of service and ways of operation. This dissertation is composed of the following seven parts.The first part is the introduction. It is designed to tackle the contradiction between the great challenges for China’s hospice and the demand for the service on the part of people. In this way, the central problem is posed. Basic methodology is also being introduced, and the theoretical and practical significance of the study is highlighted. This part mainly puts forward the problems for study, discusses the theoretical and practical significance of the research, and elaborates the research background, objectives and content.The second part involves the definition, origin and literature review of hospice. The connotation and conceptualization of hospice was studied chronologically. The prime purpose of hospice is to secure a "good death" or a "death with dignity", with an aim to improve the quality of life, instead of simply prolonging his survival. This humanitarian principle fully shows the respect for the dignity of the terminally ill. At the same time, hospice care takes into consideration the natural physiological process of the patient, without taking any aggressive measures to speed up ot slow down the death of the patient. It is in this sense that hospice differs from euthanasia. Since hospice is directly and closely related to the quality of death and the quality of nursing prior to death, theories and practices in these relevant fields just provide technical prerequisites for the emergence of modern hospice. The progress in pain killing makes it technically possible to kill or reduce pain for the patient. The establishment of "total pain" theorizes and justifies the multiple nursings for patients, which in return nurtures the development of hospice. Research on hospice covers two ranges of study: theoretical study and medical practice. However, some issues are common to both, such as the psychological condition of the terminally ill, to provide alternative perspectives for the reference of service providers, which in turn helps to improve the quality of service, and helps to promote the psychological and spiritual growth of service providers. The majority of researches carried out in Mainland China are introductory and explanatory, but some scholars have already realized the importance to base their study on the reality of China, and are thus researching on the localization of hospice service modes. The third part is the comparative study on the background of the emergence of hospice between the U.K.. and China. The dissertation gives a detailed study on the history of hospice, focuses on the transformation from charity workhouse to the medical care institutions, reviews the rise and development of modern hospice in a historical perspective, and provides an macroscopical and comprehensive background for the contrast of the background, inclusion criteria and service contents of the hospice in these two countries.The fourth part compares the inclusion and the content of hospice. British hospice is the production of caring tradition of the terminally ill, the traditional medical institutions and the development of modern medicine whose development conforms to the new understanding of death, to meet the actual needs of the terminally ill. Chinese hospice service model is basically borrowed from the United Kingdom. However, it shows a big difference in regard to the traditional conception of death and "good death" advocated by hospice. Although Chinese society is in great need of the hospice service, ordinary people are yet to be well prepared for the acceptance of the fundamental concepts, which is the major difficulty for the further development of Chinese hospice.The fifth part is a comparative study of operating models of hospice between The U.K. and China, with the specific emphasis on the form of ownership, sources of funds, service models and the supervision mechanism. The important guarantee for the development and perfection of British hospice comes from the support from the national policy, the extensive mass participation and the encouragement of diversified operating models. In contrast, this is exactly what Chinese hospice lacks. According to China’s current situation and the development of the United Kingdom and other Western countries, Chinese hospice should learn and be able to learn these strong points in order to achieve further development.The sixth part discusses the dilemma of Chinese hospice and the inspiration from the hospice care models in such developed countries like Great Britain. Basically, the practical models designed by other scholars have been based on serious consideration and scientific study to have provided important theoretical guidance. However, with the lapse of time and the emergence of new social problems, they need supplement and amendments. By reviewing the models in Britain and other developed countries, the author puts forward the basic proposition of "multi-dimensional humanistic care model" in regard to the difficulties and current problems in China.The seventh part is the conclusion and the anticipation of future development of hospice in China. It is essential for Chinese hospice to get localized based on the "borrowed" experience. Only under the sufficient assessment of current problems can we adopt others’strong points while overcoming our weak points, adjust and improve the operating models and gain long-term development, to enable hospice to benefit Chinese people. Surely, the "multi-dimensional humanistic care model" has been put in practice in some dimensions, but it is mainly a theoretical discussion. The aim is to provide some new approaches for hospice practice, and the feasibility of the model still needs inspection, adjustment and improvement in practice.