Chinese adults who have children prefer to receive end-of-life care from family members at home, while those who lost their only child preferred to be cared for in hospice or palliative care institutions.
Childlessness greatly influences adults' end-of-life care preferences, as children play an important role in traditional Chinese family-based end-of-life care. Filial piety, or respect for one's parents, is a core value in traditional Chinese culture, and children play a critical role in caring for aging parents and providing end-of-life care.
End-of-life care is the support and medical care provided during the days, weeks, or months leading up to one's death. China's one-child policy has led to a unique situation in caring for aging parents. As of 2010, one million Chinese parents had lost their only child, a number projected to grow up to 11.8 million in 2050.
Chinese adults who are their only child are particularly disadvantaged when it comes to family-based end-of-life care. In Western society, the end-of-life care model relies less on family members, instead of using hospice and palliative care institutions and professional health care providers to provide support, reduce pain, and improve comfort.
Hospice and palliative care systems are underdeveloped in China and face many structural and cultural challenges, including traditional views towards death, limited public funding, and a shortage of end-of-life care professionals at all levels.
The researchers found that adults who had their preferred child's end-of-life care provided by a specialized hospice or palliative care institution (58%), while adults with children preferred family care at home (47% for adults whose children do not live with them and 49 percent for those whose children live with them).
Our findings demonstrate a need to develop hospice and palliative care in China, both at-home care and care in hospitals and other clinical settings. Health care professionals and policymakers should recognize the particular preferences of those who have lost their only child and should develop tailored care accordingly.