Chiu - Where There Is Hope, There Is

2010·11.9 MB·English

by  Chiu, Philip Hung-wong

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
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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
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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
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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
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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.
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