Dying Before Death in the Millennium

“You wake up to see yourself lying on a hospital bed. You are being told by a doctor that you were rushed to the hospital by the taxi driver. The next thing you know you are dying. Your heart pounds as your body stays frozen. Millions of questions pop and memories of your life replay. Do I need a funeral? Do I donate my organs? What about my money? What about everyone? Will anyone remember me? Will they come and visit my grave? If anyone is ready, please open your eyes and write down your death note.”

Art therapist, Michelle Chan Wan-chee, in her mid-30s, paused the meditation session of the death-education workshop, organised by an independent bookstore, Stay Within Bookspace, in Chai Wan on a Sunday in January. She asked the 15 participants to write down their feelings and share it in small groups.

Louis Chuk Ka-lok, 21, who runs the bookstore, said his traumatic experience with the deaths of his mother and grandmother made him want to help others rehearse and prepare before death happens in real life.

Like this workshop, a handful of private organizations in Hong Kong are starting to offer interactive and reflective death education experiences, as more people call for better public awareness of the value of life and death.

Hong Kong needs death education because society is aging faster, said Lam Ching-choi, CEO of the Haven of Hope Christian Service and chairman of the Elderly Commission, at a health conference at The Hong Kong Polytechnic University.

Government data has shown an inversely proportional phenomenon on the demographics in Hong Kong.

From 2014 to 2018, the number of births in Hong Kong showed an average annual reduction of 2,150; while the number of deaths from 2014 to 2018 showed an average annual increase of 425 in four years time.

Athena Lee Hoi-ting, a 21-yearold medical student, said when death happens in hospitals, dying appears “distant and mysterious.”

“Death is so too abstract and mysterious to some. It is also unknown to some people, which makes it scary,” she said.

“Death education in Hong Kong is important because of the public’s general avoidance towards death,” said Christ Ho Tin-yan, assistant manager of The Jockey Club Life Journey Centre, a non-governmental organisation under the Senior Citizen Home Safety Association.

“We always think there will be a lot time for us to do things,” he said. “Hong Kong lacks public healthcare education on dying,” he added.

The Jockey Club Life Journey Centre in Ho Man Tin currently offers an interactive life and death experience. Participants get mock airplane tickets to use for playing games about death, even choosing the way they will die and climbing into a coffin.

“One focus of end-of-life education is to bring people together, to make each other understand life and death thoroughly,” said Mr. Ho.

“There have been visitors of all kinds, such as NGOs, secondary schools, universities, churches, business companies, and even police officers,” he added.

At The University of Hong Kong, Ms. Lee said she has offered talks and short-term courses on end-of-life care for patients, but there is currently no existing courses in her six-year curriculum that teaches about death before she enters local hospitals for clinical trainings.

Even for experienced medical staff, dying patients can be hard to handle, a British medical research paper from Queen’s University reported based on analyses of palliative healthcare for dying children.

The potential impact on medical staff, especially young doctors and nurses, include high risks of developing mental illness caused by “additional stress” and “sense of guilt” when they are unable to cure the patient or to provide follow-up bereavement support. Art therapist Ms. Chan said she uses the psychological theory of “negative visualization” as some participants have mental health issues. This technique of imagining the worst is the key to cognitive behavioral therapy, according to a British research paper on treating anorexia. It is “designed to facilitate patients to gain insight into their illnesses, albeit indirectly, boosting their motivation,” the report said.

Ms. Chan, who founded Memes & Friends, a non-profit community art organisation, said that incorporating elements of photography, words, visual arts and meditation can enhance the sense of realism in experiencing death for participants during their workshops.

Paul Wan Yat-ming, 62, who never participated in past workshops at the bookstore, said the first-time he wrote a death note was inspiring because it gave him the opportunity to review his past and contemplate the present thoroughly.

“In the past when I was studying at HKU, there were no student-initiated societies of life-and-death; Public seminars on death education have also been available at the Hong Kong Central Library, but this workshop allows me to enwrap myself in the whole process of dying in a much more realistic and meticulous way,” says Mr. Wan.

“If we were to make it a regular exercise, we leave with less regrets in the end,” said Mr. Wan.

“Death education can come in any form and through any medium, given that resources are available,” said Dani Chong, creative director of Memes & Friends.

268 high school students in Southern Italy were put into two groups, in which one provided students with “formal” death education, such as meditation practices and lectures that deliver protective religious messages related to death, while the other gave students “informal” death education through watching a film on meditation before dying, then creating a psychodrama that reproduced some aspects of the movie.”

The report says reading literature helps with death cognition and the processes of death acceptance, which reduces death anxiety; the experience of psychodrama and meditation enables students to look toward their internal world without anxiety, it states.

DEAtHFEST, part of Sheng Kung Hui Sanctuary Church Elderly Regional Center Peace Service Department, has been an active private association which focuses on providing support services and bereavement management to dying patients, families and people in grief since 2004.

It is the education of facing death, overcoming fear and anxiety about death, surpassing death, and thinking about life, enabling us to experience true love and cherish, to show humanity and to live the meaning of life, quoted from the book, Adolescent Life and Death Education, on their official website.