Ms Zhou Jiayi sought palliative care help after her father was diagnosed with cancer and the family had to have difficult conversations about treatment and his final wishes. PHOTO: COURTESY OF ZHOU JIAYI
Programme led by TTSH, Lien Foundation to train over 1,000 healthcare staff in Beijing
The Sunday Times (1 February 2026)
BEIJING – When Ms Zhou Jiayi’s father was diagnosed with cancer in October 2024, her family thought they had some time to explore treatment options.
Instead, his condition deteriorated rapidly, forcing Ms Zhou, her mother and her brother into a series of difficult conversations not only about treatment but also his final wishes. Differing opinions prompted the daughter to seek professional help from a palliative care team she found on Chinese social media platform Xiaohongshu.
"They taught me how to ask my dad questions in a way that doesn’t agitate him or make him emotional, such as what he would want us to do if there’s a need for emergency resuscitation," said Ms Zhou, 44, a counsellor by training.
"We didn’t know how to bring it up because there’s no room to talk about death in Chinese culture, especially in my family, where we are more introverted. We simply don’t cry. The only time tears are allowed is in the crematorium," she said.
Her father died in March 2025 from left adrenocortical carcinoma, an aggressive cancer that develops in the outer layer of the adrenal glands. He was 67 years old.
Ms Zhou’s experience reflects a wider reality in China where discussions about death remain deeply uncomfortable.
But as the population ages, the authorities have begun to expand and improve palliative care so as to make the end-of-life journey more comfortable for patients and their families.
In many Chinese families, particularly when the patient is elderly, relatives often shield loved ones from terminal diagnoses, believing that it is kinder to keep them in the dark. Talking openly about death is often seen as extinguishing hope, rather than preparing for what lies ahead.
This reluctance is one of many obstacles to expanding palliative care, which focuses on managing pain and symptoms along with providing emotional support, in China.
Beijing Songtang Care Hospital, the country’s first dedicated hospice and palliative care facility, was opened in 1987. But expansion has been slow, even after the National Health and Family Planning Commission released a set of standards for palliative care in 2017.
The field is not yet established as a formal medical speciality like cardiology and geriatrics, and doctors typically have to cross-train from other disciplines.
China recorded 11.31 million deaths in 2025, yet by the end of 2023, only about 185 cities and districts nationwide had pilot hospice care programmes. Hospice care is a subset of palliative care and focuses on the final phase of life.
China has over 700 cities. International comparisons suggest that China still lags behind many countries in end-of-life care, even as it makes gradual progress.
A 2021 Quality of Death and Dying study by the Lien Centre for Palliative Care ranked mainland China 53rd out of 81 countries and territories, an improvement from the 71st place it had occupied in a similar study in 2015, but still behind Singapore, Hong Kong and Taiwan.
Doctors and social workers, however, say attitudes towards palliative care in China are beginning to shift, driven by growing awareness, pilot palliative care programmes and some policy efforts to introduce end-of-life care earlier.
Singapore is helping to drive efforts in Beijing through a three-year mentor training programme launched in January, spearheaded by Singapore’s Tan Tock Seng Hospital (TTSH) and the Lien Foundation, in partnership with hospitals and social work agencies in the Chinese capital.
The $1.3 million programme, including funding by Lien Foundation and training support from TTSH, is expected to train more than 1,000 healthcare professionals in Beijing, focusing on both clinical skills and navigating conversations around end-of-life care.
Dr Neo Han Yee, who heads the department of palliative medicine at TTSH, said the aim is to introduce palliative care earlier in the course of illness to improve symptom control and allow families to plan in advance rather than scrambling to make decisions in crisis during a patient’s final moments.
In China, as in Singapore and other Asian societies shaped by Confucian values, filial piety can hinder conversations about death, but the hurdle is not insurmountable, he said.
"In these societies, the idea of a good death is equally important," said Dr Neo. "We can change the conversation and start talking about death earlier, so that the dying process is better planned and families have greater clarity."
Dr Neo said Singapore’s experience shows what sustained institutional commitment can achieve.
Palliative care started gaining traction in the 1980s and has since been integrated into mainstream healthcare, supported by clearer financing structures that have led to lower out-of-pocket costs for patients, he said.
Chinese doctors involved in palliative care say the challenge at home is less about intent than system maturity, citing gaps such as the lack of standardised training pathways and a shortage of specialised professionals.
Dr Qin Yuan, who heads the palliative care department at Beijing Haidian Hospital, was among the first group of doctors in the capital city to pioneer such services nearly a decade ago. Her hospital was one of the first in Beijing to officially establish a hospice care ward in 2017.
"At that time, my colleagues and I were unsure if we were doing it right. But we knew this was work that provided help when it was most urgently needed, like delivering coal in the middle of winter," said Dr Qin.
While awareness of palliative care has improved since then and the government has expanded the palliative ward pilot programme to more cities and districts nationwide, Dr Qin said the overall system remains insufficiently structured as doctors largely depend on themselves to transition across disciplines to practise palliative care.
Financing is another major constraint. Although some programmes allow certain palliative services to be subsidised by the government, the coverage remains uneven and non-medical support such as counselling is often excluded.
Doctors said this discourages hospitals from expanding services and reinforces the perception that palliative care is optional rather than essential. As medical services struggle to keep pace, social service organisations have stepped in to fill critical gaps, particularly in emotional support and family decision-making.
Ms Yang Jie, director of social work agency Sereniturn Palliative Care, says her team often works not just with patients but also with entire families to navigate complex decisions.
She said the legacy of China’s one-child policy has reduced family sizes, often placing the burden of decision-making on a single adult responsible for two elderly parents. "As family structures weaken, that responsibility can become overwhelming," she said. Her team provides emotional counselling on top of helping families access services such as the doing up of wills and financial support.
At the same time, Ms Yang said she sees signs of change. The Covid-19 pandemic, she said, made death "more visible and real" while increased media discussion around life and death education has begun to make conversations about dying less taboo and less delayed.
For Ms Zhou, the support her family received did not end with her father’s death. Social workers continued to check in, offering counselling and group activities with other families that had faced similar losses which she said helped her process grief over time.
It has also shaped her own plans as Ms Zhou now volunteers with a palliative care team and plans to receive formal training in this area. "My experience made me realise that what seems like filial piety on the surface was in fact avoidance. I hope I can help more families come together and comfort each other," she said.