The attitudes of Chinese family caregivers of older people with dementia towards life sustaining treatments

Abstract

More dialogue and education are needed about end of life issues in the early phase of dementia. Nurses should be aware of the cultural implications of surrogate decision-making for Chinese family caregivers.

The Meaning of Food amongst Terminally Ill Chinese Patients and Families in Singapore

“…In part, this stance ties into the view that the act of providing food is seen as an expression of love and caring (Garanis-Papadatos and Katsas 1999, Bowman 2001, McClement et al 2003, Chiu 2004, Kwok et al 2007, Ke 2008, Ho et al 2010, Krishna 2011a, 2011b, 2011c, Chai et al 2013. Therefore discontinuing with the provision of food is seen to be callous and likened to severing all links and relationships with one's family particularly within a society that sees a patient's declining status in the terminal stages of cancer not as a function of disease progression but of decreased food intake (Slomka 2003, Ho et al 2010, Krishna 2011a, Chai et al 2013.…”

“…They felt that without nutrition, their mother would effectively starve to death and this would reflect a failing in their filial duties According to Confucian belief, filial piety is essential for one's own well-being and happiness and arises from meeting one's obligations to provide for the material and mental well-being of one's aged parents (Lai and Surood 2009). Such beliefs underlie some of the conundrums faced by families in setting out end of life plans and particularly when contemplating decisions to forgo life sustaining therapies (Kwok et al 2007).…”

“…As a result the family opted for NG (Naso-Gastric) feeding despite being cognizant of the fact that it was unlikely to provide any meaningful comfort to her, nor improve her _______________ Victoria HM Wong and Lalit Krishna (2014), JMED Research, DOI: 10.5171/2014.670628 quality of life or her overall prognosis (Krishna 2011a, Ho et al 2010. They were also aware that quite to the converse, this intervention could cause her harm and discomfort however for the family, the overarching concern remained focused upon meeting their filial duties which they believed took the form of feeding their mother (Garanis-Papadatos and Katsas 1999, Bowman 2001, McClement et al 2003, Chiu 2004, Kwok et al 2007, Ke 2008, Ho et al 2010, Krishna 2011a, 2011b, 2011c. They felt that without nutrition, their mother would effectively starve to death and this would reflect a failing in their filial duties According to Confucian belief, filial piety is essential for one's own well-being and happiness and arises from meeting one's obligations to provide for the material and mental well-being of one's aged parents (Lai and Surood 2009).…”

“…Therefore discontinuing with the provision of food is seen to be callous and likened to severing all links and relationships with one's family particularly within a society that sees a patient's declining status in the terminal stages of cancer not as a function of disease progression but of decreased food intake (Slomka 2003, Ho et al 2010, Krishna 2011a, Chai et al 2013. Family members tend to feel that the provision of more calories would halt, or reverse this decline (Bowman and Singer 2001, McClement et al 2003, Chiu 2004, Kwok et al 2007, Ho et al 2010, Krishna 2011a, Chai et al 2013. Additionally, many are under the impression that any withholding or withdrawing of food would result in suffering, pain and a hastening of death (Bowman and Singer 2001, McClement et al 2003, Chiu 2004, Kwok et al 2007, Ho et al 2010, Krishna 2011a, Chai et al 2013.…”

“…Family members tend to feel that the provision of more calories would halt, or reverse this decline (Bowman and Singer 2001, McClement et al 2003, Chiu 2004, Kwok et al 2007, Ho et al 2010, Krishna 2011a, Chai et al 2013. Additionally, many are under the impression that any withholding or withdrawing of food would result in suffering, pain and a hastening of death (Bowman and Singer 2001, McClement et al 2003, Chiu 2004, Kwok et al 2007, Ho et al 2010, Krishna 2011a, Chai et al 2013. Death by starvation is particularly concerning given the Chinese believe that death in such circumstances, will result in a 'starving soul' or 'hungry ghost' after death (Goh 2007, Goh 2008.…”