Chinese medical students get life training for death

Life's greatest certainty is its end. This reality has prompted Yale philosophy professor Shelly Kagan to examine in his class twice a week shared beliefs about death and consequential moral questions. The university course was recorded for open courses and put online in 2007.

But Peking University Health Science Center professor Wang Yifang found the course to be too long, academic and philosophical for students in their early 20s to understand how to face death with respect and rationality.

"The lack of death's proper acknowledgement arises from one of the biggest problems our society faces - the poverty of faith - and it has caused a lot of social problems," Wang says.

"Accompanied by a variety of temptations, we move toward utilitarianism, technological paramountcy and consumerism. So we bet our meanings of life and happiness on them. Thus our society has a distorted view of the nature of death."

While his Dialects of Nature course is about contemporary Chinese Marxist philosophy, Wang inserts perspectives about life and death he believes are necessary for medical students, who will soon find themselves directly dealing with these issues.

"Medical students should understand death issues at age 25, while ordinary people usually gain such understandings at 45," he says.

After inviting Confucian scholars to talk about the Chinese sage's concept of death for hours in his class, he found students were still at a loss. They're too young, and few have experienced the deaths of their loved ones, let alone of their patients.

He decided these future doctors must first gain an awareness in a virtual environment by immersing them in death literature, theatre and film.

He calls it "death training".

Students or doctors who've worked in an emergency room, cancer treatment department or intensive-care unit should write their personal stories about when they've faced death so other doctors can identify with them, he believes.

Fudan University professor Hu Zhihui, who also teaches Marxism, started a similar course called Life Education.

His approach is to coach students to select their own death-related topics. About 20 sit in a circle and each shares an experience with death - be it of a friend who committed suicide or a relative who died of disease. Sessions appear more like a self-help group than a university course.

"I don't talk theory in class," Hu says.

"I dedicate most of our time to enabling students to share their experiences. I believe a person's own experiences with death can have the greatest impact. So, in this class, we shed our heavy moments and identify the sparkles of humanity.

"This course will not give answers or reveal how to endure death. But we enrich our lives through others'. So we're more tolerant and understanding of life."

Wang takes a different tact.

He tells each semester's first class: "I'm 55 years old. You guys are on average 25. Who's closer to death?"

The students all laugh.

He responds: "You laugh because I'm much older than you - hence I seem closer to death than you. But death can come upon any of us suddenly. So we all keep an equal distance from it."

Wang believes the dissemination of knowledge about death is useless because knowledge is not faith, and death discussions should relate to one's personal beliefs. He hopes to unleash in his students a sentiment about death that can move people and touch the soul.

"I don't have answers about death," Wang says.

"Death doesn't provide anything that reveals its full self to us. All we have are narratives about our own deaths that are worth discussing. I hope everyone can discover their own value and make peace with death."

Wang explained there are three medical philosophy categories - death, technology and doctor studies. Medical students should be trained to develop philosophical reflections. They work on the front lines between life and death every day.

Doctors should know more than medical procedures. They should possess a deep understanding of life, he believes.

According to this logic, a component of his death outlook is understanding modernity's negative impact on life and death. Technology is not the panacea to death, he contends.

"Advanced medical technology brings risks and costs patients a lot," Wang says.

"I want to teach students they should seek beyond technology and love patients. Today, most of the doctors have blind faith in technology. This doctrine brings indifference and bias toward patents' suffering and true feelings. But doctors should go beyond that and revere virtue. The profession needs to return to altruism."

Wang teaches different levels of death philosophy to different students. To PhD students, he teaches 16 lessons for the entire course. Every student has to at least write a report on one of his recommended books on death issues to develop their individual understandings.

Students who've witnessed relatives' deaths are required to record their true feelings. Those who've already undertaken clinical trials are taught to how to say the right words to a departing patient and relatives.

He doesn't restrict students' topics.

"I ask my students how they feel about suicide - do they think it's selfish or cowardly? But, actually, if a person finally decides to throw his life away, he must overcome cowardice because dying requires more courage than living. This is not to condone such behaviour. But such tragedies happen more when people are reluctant to talk about it."

By citing the most vivid life-and-death stories, such as Steve Jobs' and Leslie Cheung's, he hopes the pursuit of life-and-death awareness can help doctors ponder life's meaning and extend beyond a myopic focus on technology to also think about love.

"One of my students witnessed an old man during his last hours undergo endless electric shocks to prevent heart failure," he says.

"Every time he was shocked, the old man, lying in bed, wanted to whisper to his family. They encouraged the doctor to keep trying to revive him. But death inevitably came at last, and the family lost its last chance to pacify the old man's soul."

He asks students to combat death like generals.

"They'll have to fight death. But sometimes it's wiser to compromise."