Content uploaded by Gertina J. Van Schalkwyk
Author content
All content in this area was uploaded by Gertina J. Van Schalkwyk on Oct 24, 2018
Content may be subject to copyright.
Full Terms & Conditions of access and use can be found at
http://www.tandfonline.com/action/journalInformation?journalCode=udst20
Death Studies
ISSN: 0748-1187 (Print) 1091-7683 (Online) Journal homepage: http://www.tandfonline.com/loi/udst20
Death preparation of Chinese rural elders
Yanping Liu & Gertina J. van Schalkwyk
To cite this article: Yanping Liu & Gertina J. van Schalkwyk (2018): Death preparation of Chinese
rural elders, Death Studies, DOI: 10.1080/07481187.2018.1458760
To link to this article: https://doi.org/10.1080/07481187.2018.1458760
Accepted author version posted online: 14
May 2018.
Published online: 14 Sep 2018.
Submit your article to this journal
Article views: 15
View Crossmark data
Death preparation of Chinese rural elders
Yanping Liu
a,b
and Gertina J. van Schalkwyk
a
a
Department of Psychology, University of Macau, Taipa, Macau, China;
b
Department of Psychology, Honghe University, Mengzi, China
ABSTRACT
In this qualitative study, we explored how Chinese rural elders narrate death-related issues
and death preparation. Adopting a phenomenological approach, we interviewed 14 partici-
pants regarding the particular actions they employ to prepare for death. The findings
revealed a death preparation system for rural Chinese elders that is instrumental in how
they converse about death, wish for a good death, make objects and symbols, and antici-
pate an afterlife as a worshiped ancestor rather than a wandering ghost. Family and family
honor provide the context for death preparation. We discuss implications and the need for
the death preparation education of younger generations.
Introduction
Death is a natural and integral part of life (Wong,
Reker, & Gesser, 1994), and approaching death is
something most people have to deal with toward the
end of life. Encountering death could be unpleasant
and anxiety-provoking (Hui & Coleman, 2013;
Neimeyer, Wittkowski, & Moser, 2004). On the other
hand, a proactive way to deal with end-of-life issues
and death-related stress may be to prepare for death
(Chan, Chan, Tin, Chow, & Chan, 2007; Yalom, 1980,
2008). Studies addressing the end-of-life complexities
and death-related issues experienced by rural elders
are few and most research focuses on advance care
planning for the elderly in urban Chinese settings
such as Hong Kong (Chan et al., 2007; Ming-lin &
Lang, 1998; Mjelde-Mossey & Chan, 2007) and
Singapore (Chan & Yau, 2010). Other research investi-
gating end-of-life issues focuses on mental health and
coping strategies for left-behind elders in rural China
(e.g., Cui, Wang, & Zhang, 2011), and research
regarding death preparation among Chinese elders in
deep rural areas of the south has thus far
been neglected.
China is officially a country of many peoples and
ethnicities, and nearly three quarters of the ever-
expanding Chinese elderly live in rural areas (Li, Chi,
& Xu, 2013). A great number of elders are left behind
in rural areas by the younger generations migrating to
urban areas (Norstrand & Xu, 2012) and without the
resources to cope with end-of-life issues and death-
related stress. Many of these rural elders are less edu-
cated, have fewer financial and social resources, and
seemingly do not or cannot engage in advance care
planning such as buying life insurance, signing wills,
finding care facilities for fragile elders, or securing a
burial place (Chan et al., 2007). It is thus problematic
to transfer research from urban settings in China (e.g.,
Hong Kong, Shanghai) to understand how elderly in
rural areas prepare for death (Chan & Yau, 2010). In
this study, we aim to describe how rural Chinese eld-
ers, who are in the latter phase of life and living in a
village in the deep south of China, think and talk
about death, and the actions they take to prepare for
death. Adopting a phenomenological approach, we
intend to give voice to the grandparents and elders in
a rural village with the central question: “How do
rural Chinese elders talk about death and make sense
of life through death preparation?”
Death preparation
Death preparation refers broadly to the actions one
takes to arrive at a calm acceptance of one’s own mor-
tality. In this study, death preparation refers to the
actions one takes to prearrange the end of one’s life-
span (Chan & Yau, 2010). It includes thinking and
talking about death, deciding to die well, and engaging
in activities that will ensure good dying. Thinking and
talking about death makes us aware of both living and
CONTACT Gertina J. van Schalkwyk gjvsumac@gmail.com Department of Psychology, University of Macau, Avenida da Universidade, Taipa, Macao
(SAR), China.
ß2018 Taylor & Francis
DEATH STUDIES
https://doi.org/10.1080/07481187.2018.1458760
dying, a process of making sense of life because
“though the physicality of death destroys us, the idea
of death saves us”(Yalom, 1980, p. 40). We may pon-
der how to spend the remaining period between the
present and the moment of dying, so that we live well
enough to die well. Death preparation can happen for
everyone at any time of life when he/she reflects upon
his/her life and/or the end-of-life issues of a family
member (Chan et al., 2007; Chan & Yau, 2010). The
inclination to prepare for death, however, might be
stronger for those who are closer to the end of
their lifespan.
Haj and Antoine (2016) view death preparation as
one of the functions of reminiscence and aimed “at
deriving a sense of continuity and meaning in one’s
life …that also contributes to a sense of closure and
calmness in older adults”(p. 520). In more traditional
and rural Chinese communities, there is no real fear
of death but talking about death is considered by
some as a social taboo (Chan & Yau, 2010). Rather,
Chinese people generally avoid talking about death
because they believe conversations about death could
bring negative consequences like evoking evil spirits
(Chow & Chan, 2006). On the other hand, Chinese
people who believe in the afterlife and value ancestral
worship speak highly of the dying process, funerary
rituals, and ceremonies that represent safe transition
into heaven and the afterlife (Mjelde-Mossey & Chan,
2007; Webster, Bohlmeijer, & Westerhof, 2010).
A good death, although perceived differently from
culture to culture and from the perspectives of the
dying person, broadly refers to dying nobly or to be
prepared to meet one’s death without fear (Howarth
& Leaman, 2003 ; Yalom, 2008), and to a slow and
lingering end of life as fitting the expectations of a
continued connection between the living and the
dying. Hart, Sainsbury and Short (1998) refer to a
good death as the kind of death that takes place as a
public event, for example, in the dying person’s home
where family members, friends, co-workers, and even
some members of the community have an opportunity
to surround and support the dying person. Taking
action to prepare for death is to carry out the decision
to die well and ensure transition to the afterlife. It
includes activities such as purchasing life insurance,
writing a will, planning for one’s property distribution,
the funeral, and so on (Chan & Yau, 2010; Pinquart &
Sorensen, 2002; Robbins, 1991).
For those near dying, advance care planning is a
further step making arrangements about how one
wants to be treated (Mullick, Martin, & Sallnow 2013)
and to die well. Mak and Clinton (1999) claimed that
family members are instrumental in assisting with
end-of-life issues and socio-emotional care in later life.
Additionally, when talking openly about death prepa-
rations as is the situation with advance care planning,
family members or caregivers learn about the expecta-
tions of the dying person and the preferred burial rit-
uals. They can also prepare to perform the necessary
rituals for the dying person as per his or her wishes
(Mullick et al., 2013). Preparing for death is not only
helpful for the dying person to gain a sense of integ-
rity and certainty about the uncertainty of dying and
the afterlife (Firestone & Catlett, 2009), it is also bene-
ficial for family members (Carr, 2003; Chan, Tse, &
Chan, 2006). Death preparation also helps with family
members’grieving process and, contrary to a sudden
or accidental death, reduces stress that might compli-
cate the grief reactions (Neimeyer & Sands, 2011).
Thus, death preparation is an ongoing process that
could start early in life (Gielen, 1997), and family
members and caregivers benefit from death prepar-
ation when they relieve the dying person from further
stress by accepting the impending death.
Framing of the study
Studies pertaining to death and dying, as well as death
preparation, provide useful but limited understanding
of the phenomenon in rural areas (Chan et al., 2007;
Chan & Yau, 2010; Ming-lin & Lang, 1998; Mjelde-
Mossey & Chan, 2007). Although some studies address
death-related attitudes and coping with end-of-life
stress in rural China (e.g., Chen, Jin, & Guo, 2006;
Norstrand & Xu, 2012), research regarding death
preparation among Chinese elders in deep rural areas
of the south is uncommon. In particular, there is little
attention regarding how rural Chinese elderly talk
about their own impending death and how they pre-
pare for dying well. In Western societies, research on
death and dying has progressed markedly from earlier
stage theories. Adopting a holistic approach, Corr
(1992) acknowledged individual differences, rejected
broad generalizations, and emphasized four dimen-
sions or tasks that the dying person must face. The
task–work approach involves recognition of bodily
needs, psychological security, interpersonal attach-
ments, and spiritual energy and hope. Kastenbaum
(2012) expanded on Corr’s approach, proposing a way
for understanding society and people’s roles within
that society when faced with death, their own death,
or that of a loved one.
Kastenbaum (2012) proclaimed that death is a com-
plex system integrating “the interpersonal, socio-phys-
ical, and symbolic network through which an
individual’s relationship to mortality is mediated by
2Y. LIU AND G. J. VAN SCHALKWYK
society”(p. 102). The death system, with its five ele-
ments (i.e., people, places, times, objects, and symbols)
and seven functions (i.e., warnings and predictions,
preventing death, caring for the dying, disposing of
the dead, making social consolidation after death,
making sense of death, and killing), explains who and
what is involved in the context of death, as well as
attitudes regulating people’s behavior related to death.
This sociocultural and systemic view of the death sys-
tem paved the way for us to frame the current study
regarding the elements and functions of death prepar-
ation among Chinese rural elders, and how these rural
elders make sense of life through their reminiscing
and actions preparing for death.
Methods
The study of the death preparation of Chinese rural
elders is a part of a larger project on life storytelling
and reminiscing, which received ethical approval from
the University of Macau. To the best of our know-
ledge, the larger project is a first inquiry regarding the
role of reminiscence in the identity construction of
rural Chinese elders, and we opted for narrative
inquiry (McAdams, 2008; Riessman, 2007) and a phe-
nomenological methodology (Moustakas, 1994).
Narrative inquiry and phenomenology allowed us to
interview elders living in a small village in southern
China, giving voice to a minority group often
neglected in ageing research. For the purpose of this
study, we extracted parts of the interviews from the
larger study, focusing on the central question of how
rural Chinese people talked about death and made
sense of life through death preparation. Only the sec-
tions specifically related to death and their actions to
ensure a good death were used for analysis and
reported here.
Participants
We recruited participants through purposive snowball
sampling, identifying several key participants and ask-
ing them to introduce us to other participants
(Merriam, 2009). In terms of the recruiting criteria,
we made sure participants identified as both a rural
resident with registration in the local community or
hukou (i.e., the Chinese system for categorizing citi-
zens according to their socioeconomic status and liv-
ing arrangements) and an elder, which was
determined, according to village tradition, by someone
already having a grandchild. Local people do not have
retirement; they believe becoming a grandparent
marks the beginning of old age, no matter the
person’s actual age. Older adults with diagnosed phys-
ical and/or psychological disabilities (e.g., age-related
hearing loss, dementia syndromes) were not included
as these disorders were considered barriers for
interviewing.
In the current study, we interviewed 14 volunteer
elders recruited according to above criteria. They were
between 47 and 85 years of age, with only three par-
ticipants younger than 60 years of age (M¼69.14,
SD ¼11.04; N
women
¼7). Nine elders reported declin-
ing health but none had any clinical diagnosis for
mental health disorders, and all participants were able
to talk freely and respond to the interview questions.
Seven participants had no prior formal education,
while the other participants had 1 to 5 years of
schooling. Thirteen participants were married and one
was widowed. Living arrangements varied with seven
participants living with their spouses separate from
other family members, and the other seven living in
intergenerational family settings. Most local people in
the village are peasants working in farmlands. Some of
the younger residents migrate to cities for work but
return home regularly, especially during traditional
festivals and holidays. Residents of the village are
related either by blood or through daily living, work-
ing, and leisure interactions.
Data collection
The first author carried out one-on-one interviews
with each of the 14 elders, between January and July
2016. All interviews were conducted in the local dia-
lect and audio-recorded with verbal consent from the
participants. Participants were free to choose where
they wanted to be interviewed, and the venues varied
from their living rooms, a private room in their house,
porches of their houses, or a room in the house of a
neighbor. The interviews varied in time from 42 to
108 min (M¼79).
Only one interview per participant was conducted.
The interview was semi-structured using an adapted
version of the Life Story Interview schedule (LSI;
McAdams, 2008) as guideline. Each interview pro-
gressed following three steps: (1) introducing the aim
of the interview and related issues (e.g., confidential-
ity), (2) listening to the participant’s autobiographical
telling, and (3) probing certain unclear dimensions in
his/her storytelling. Most participants were eager to
tell their stories without interruption. In cases where a
participant did not know what to say or shared very
little about his/her life, or when a participant’s telling
became repetitive or without new information,
prompts were used to maintain the focus on life
DEATH STUDIES 3
storytelling and death-related narrating. Example ques-
tions were as follows: what are your thoughts and per-
ceptions about death; have you made any preparations
for your own death; what preparations have you made
for your own death; and why do you consider these
preparations important?
Throughout the data collection process, we consid-
ered the participants’benefit and protection from
potential risks. Before starting the interview, each par-
ticipant was informed about the study purpose, audio-
recording of the conversation with the interviewer,
and confidentiality of personal information. Since
most participants had limited or no education and
could not read or write, or were reticent writing his/
her name because of earlier social–political persecu-
tion experiences during the Cultural Revolution
period, consent was recorded verbally. Refreshments
were provided after the interview as a token of appre-
ciation, and participants did not receive any monetary
compensation. No coercion took place and all partici-
pants were free to stop the storytelling at any point in
time without any consequence.
Data analysis
Since we assumed death preparation to be contextual-
ized in the participants’everyday lives, we gathered
the participants’life stories and then extracted only
their death-related narratives for further analysis. Data
analysis involved a continuous process via concurrent
interviewing, transcribing, memo-writing, member
checking, peer review, and researchers’reflection. We
examined each narrative regarding the follow-
ing questions:
Does the rural elderly talk about death and death
preparation, and if they do, how do they talk
about it?
Does the rural elderly care about a good death, and
if they do, why?
How do the rural elderly we interviewed make
sense of life by preparing for death, and what
actions do they take to prepare?
We used thematic analysis to identify and analyze
patterns within the dataset following the six phases
proposed by Braun and Clarke (2006). In this regard,
we familiarized ourselves with the data, first tran-
scribed the audio-recorded interviews into text format,
and translated the Chinese version into English for
the benefit of the second author who is not familiar
with Chinese writing. Although some of the finer
nuances of expression could be lost in the translation
process, we enlisted the assistance of bilingual col-
leagues (i.e., doctoral students and staff in the depart-
ment) to review the transcripts for accuracy and
capturing the intent of participants. Next, we inde-
pendently coded the textual data generating initial
codes and searching for themes in response to the
above questions. Reviewing the themes several times,
and defining and naming the themes provided a pre-
liminary model for describing the ways in which rural
Chinese elderly made sense of death through death
preparation. In cases where our analysis of the textual
data diverted, we discussed alternatives and included
only those themes for which consensus could be
reached, and in response to the central question for
this study. Establishing trustworthiness and credibility
was a continuous process involving member checking
and maintaining an audit trail. After the initial analy-
ses, the first author conducted member checking with
key participants in the community to confirm the ten-
tative interpretations and discussed the findings with
local people.
Findings and discussion
The analysis yielded four themes –death conversation,
good dying, death preparation as instrumental, and
death preparation as taking action –representing the
death preparation mechanisms employed by elders liv-
ing in a rural community in southern China.
Maintaining the narrative approach, the findings and
discussion are integrated and where relevant, partic-
ipants’own voices are included. We conclude the dis-
cussion with a preliminary model of death preparation
for elderly Chinese (Figure 1).
Death conversation
The participants we interviewed talked freely and
openly about death as a natural and inevitable part of
life. They used a “grass-people”metaphor to describe
Death
Preparaon as
Instrumental
Death
Conversaon
Context: Family
Good Dying
Aerlife &
Ancestral
Worship
Making Objects
& Symbols
Figure 1. Rural death preparation system.
4Y. LIU AND G. J. VAN SCHALKWYK
their living and dying: just as grass grows and withers
seasonally, people do what they must do naturally at
certain phases of life (e.g., getting married, having
children) and then they die like the grass in winter.
Participants were comfortable telling stories about
accidental near-death experiences, their own impend-
ing death, death of community members, and suicide
attempts of their parents, children, siblings, or neigh-
bors. For example, Mrs. O. (59 y/o) described her
father’s suicide attempts during the Land Reform
period (during the 1950s), her parents’dying and the
funeral proceedings, her own near-death experiences
in a hospital when she was 28 years of age, as well as
her recent actions preparing for death by making cof-
fins for herself and her husband. For the most part,
participants talked about death as natural and some-
thing for which one should be prepared in advance,
whether to accept the inevitability of death or to take
actions ensuring a good death.
Participants also talked about death as part of one’s
destiny. “Everyone has that day [the end of life] …
This is what destiny is about. How long a person can
live is decided”(Mrs. O.), and of heaven/hell and an
afterlife. Heaven for them is the ultimate destination
and not something to be decided by the individual
her/himself. Mrs. N. (76 y/o) commented: “When the
moment comes, just go with it. I will go whenever the
heaven wants me,”and Mrs. P. (72 y/o) added: “When
heaven wants me …it [dying] is just like falling asleep
there is nothing [I could do].”A natural death is good
for one’s afterlife and thus good for obtaining the liv-
ing generations’worship. Participants generally
seemed to believe that a natural death is preferable to
one where death is brought on by accidents, failed
surgery, or suicide. Such interference or unnatural
death could negatively affect a person and perhaps
even result in him/her becoming a wandering ghost in
hell. Mr. G. (71 y/o) particularly mentioned: “If a per-
son is not meant to die but he poisons himself to
death, there would be no road in the hell for him to
walk …the hell will not even accept him.”
Culture and religion provided context and content
for talking about death and the wish for a good death
through properly preparing in advance. The partic-
ipants’narratives about death were contextualized in
their rural surroundings, and they presented unique
expressions (e.g., the “grass-people”metaphor), rela-
tively unique to rural people working in farmlands.
The finding that rural elders openly talking about
death is consistent with research reports of urban
Chinese populations (Chan & Yau, 2010; Ming-lin &
Lang, 1998), although contrary to the general view-
point that conversations about death and death
preparation are a social taboo in traditional Chinese
societies (see Chow & Chan, 2006; Mjelde-Mossey &
Chan, 2007). Mjelde-Mossey and Chan (2007) specu-
lated that contemporary Chinese people living in
urban areas are less likely following traditional values
affirming the inconsistence between empirical findings
and folk beliefs. However, in our interviews with the
rural elderly in the village, it seemed that conversing
about end-of-life issues such as death and death prep-
aration was common practice. For them, talking about
death was natural and taking action to prepare for a
good death expected not only by the individual but
also by the community more generally.
Good dying
The participants we interviewed conversed at length
about prearrangement for good dying and pursuing
traditional practices when on one’s death bed. Good
dying rituals for the participants include having their
children gathered around the death bed, specifically
the oldest son who has to perform the first ritual
when his parent dies. The sons are also the ones
expected to put the body of his deceased parent into
the coffin, cater for a big funeral ceremony, and bear-
ing the coffin to the ancestral cemetery. Overall, the
participants in our study believe that having children
–particularly having a son and grandsons –was the
most important achievement in life and vital for hav-
ing a good death and good afterlife. Mr. B. (80 y/o)
said, “What is the purpose of living in the world? A
human must leave successors, like grass leaving roots.”
Such a belief is shared commonly, even among the
elders who feel their children will not support them
when they are really old.
Having no sons and grandsons could be humiliat-
ing for the elders in the village both while they are
alive as well as when approaching death. For them,
having no sons and grandsons precludes one from
dying well and from entering the afterlife.
The ancestors always said, humans have to have sons
for posterity, like leaving grass roots …Having
children is the continuation of Chinese society …if
he has no son, the continuation is broken …the
ancestors would say having no sons and grandsons
means he is not qualified to be buried in the ancestral
graves. (Mr. G., 71 y/o)
Raising a good son to host a beautiful funeral
ceremony is like having a good father to host a
beautiful wedding ceremony. (Mrs. M., 71 y/o)
Mrs. O. (59 y/o) mentioned a funeral ritual valued
by local people, namely having someone “catch the
DEATH STUDIES 5
dying person’s last breath.”It seems that for one’s
death to be a good one, the children would gather
around the death bed and when noticing the moment
when his parent expresses her/his last breath, the old-
est son in the family should lift up the deceased par-
ent while other siblings change the parent’s clothes. It
is good to catch the parent’s last breath at the right
moment, so that the body is still warm and soft, and
it is easy to put on the burial shrouds. Thus, being
prepared and having sons, especially the oldest one,
around when one dies is important for elders living in
this rural village.
Such a son preference for participants comes from
the traditional belief that only sons can continue the
family’s care and lineage because daughters leave their
family of origin to care for in-laws upon marriage (Sit,
2017). Chinese ancestor worship, according to Yick
and Gupta (2002),“entails praying for the lineage on
the male’s line of descent”(p. 33). In the village, once
daughters become wives, they are treated as relative
“outsiders”to the original family, living with another
family that can be very far away from their parents.
Sons, in contrast, married or not, are supposed to live
with or near their parents, take care of the parents
when they are really old, and conduct the funeral rit-
uals. Son preference for a good death is a shared trad-
ition in other Asian cultures, too. B
elanger (2002)
found rural Vietnamese attributed special spiritual val-
ues to sons who are not only perceived as the ones
who carry on the family line, but also the ones to per-
form the cultural rituals, cater for parents’funeral cer-
emonies, and celebrate the death anniversaries.
Mjelde-Mossey and Chan (2007) pose that death is
the turning point into the afterlife, while death prepar-
ation is a way to construct a good afterlife. In the
afterlife, one becomes an ancestor who is believed to
play an important role in blessing the family and con-
necting generations of families (Yick & Gupta, 2002).
It is believed that if the ancestor has a good afterlife
and is worshiped well, they can bless the family with
good luck and avoiding misfortune. Chinese elders in
the rural south also want to resolve unfinished busi-
ness before the death (Chan et al., 2006) and forgive
past transgressions against them. Reminiscing, the par-
ticipants in our study told stories about the challenges
they faced in the past, interpersonal conflicts, and
their children’s unfilial attitudes and behaviors.
Nonetheless, when talking about their own impending
death, many participants said: “There is nothing you
could do [then],”and they pursued ways of forgive
and make peace with past sufferings as part of their
death preparation and constructing a good death.
The notion of family support as integral to a good
death for the Chinese rural elderly aligning with
reports from urban Chinese elders (Chan & Yau,
2010), Vietnamese rural residents (B
elanger, 2002), and
elders from Western cultures (e.g., Carr, 2003; Mullick
et al., 2013). However, the spiritual value of the oldest
son seems particularly important for Asian cultures
(B
elanger, 2002) as a means to ensure good dying and
gain entrance to a good afterlife. The preference for
oldest son at one’s death bed is usually cultivated at a
young age through daily interactions with ageing
people in the community. With the rural-to-urban
migration of the younger generation in recent years, it
is possible that younger generations have lost the
opportunity to learn about these expectations of their
ageing parents, leaving the elderly with uncertainty
about how to prepare appropriately for death.
Death preparation as instrumental
For the elderly we interviewed, death preparation is
instrumental for a good death and afterlife. It is also a
way to sacrifice oneself in order to save the next gen-
erations from difficulties. In her death preparation,
Mrs. M. (71 y/o) declined the possibility of going to
hospital given her ill health considering the cost it
might imply to her sons and wanting to spare them
the expense: “He [her husband] said I should go to
the hospital. I think it would not make much differ-
ence. I am already 71 years old. Do I want to recover?
That is not possible. And …the sons often give me
money when they come back home but I just do not
want it.”Mrs. M. refused the prospects of a longer
life, sacrificing her own well-being in order not to
burden her sons.
Other participants are seemingly prepared to take
their own lives (e.g., suicide), partly to avoid humili-
ation for the children in the village and partly as pay-
back to their adult children’s lack of caregiving. In the
village, it is supposed that the adult son’s family will
take care of his elderly parents when they can no lon-
ger live by or care for themselves. However, sensing
the helplessness of being alone in his final days, Mr.
D. (68 y/o) considered preparing for death taking mat-
ters in his own hands committing suicide as a way to
end his life. He also wants to punish his unfilial son
and daughter-in-law, saying:
We [his wife and him] cannot rely on the
children …when I cannot cook for myself, eat by
myself or when I am really ill …when I am very near
death. …I will make a small bottle of pesticide, and
carry it with me all the time. When I am really
suffering and hungry, with no one to look me, I will
6Y. LIU AND G. J. VAN SCHALKWYK
just lift up the bottle and drink it and go to sleep in
the bed and go to see the king of hell. …Others in
the village will judge our daughter-in-law for treating
us badly …I want a social judgement.
In the Chinese rural tradition, suicide is one type
of planned death sacrificing heroically for the good of
others or minimizing the miseries of a poor living and
unfilial children (see Liu & Wang, 2013). Whereas
Mrs. N. (76 y/o) claimed that “When that happens
[dying], no matter how I suffer, I will bear it. I do not
consider other ways because it [committing suicide]
influences the family,”and is willing to sacrifice her-
self to avoid her son’s humiliation, Mr. D. seemed to
consider suicide as a way of punishing his family
members who, because of the suicide, will lose face in
the community. Mr. D’s intentions appeared to fit Liu
and Wang’s(2013) theory regarding the four types of
suicidal motivation among Chinese rural residents: for
one’s own good (e.g., to terminate suffering), for the
good of others (e.g., to substitute son’s severe punish-
ment in villages), for retaliation (e.g., to punish unfilial
son or daughter-in-law), and due to a sense of help-
lessness. Unlike urban elders who prepare for death
anticipating a good afterlife and becoming a wor-
shiped ancestor (Chan & Yau, 2010; Mjelde-Mossey &
Chan, 2007), some rural elders seem willing to give up
this idealized future arranging for their own death
through suicide and becoming a “wandering ghost”
(Mr. G. regarding dying an unnatural death).
Death preparation as taking action
As anticipated in this study, taking action and making
objects and symbols associated with death and dying
was important and necessary for the participants in
our study. “It [the coffin] should be prepared. You
may see he is quite healthy now but who knows, some-
day, suddenly, right …he may die. If you have to
hurry up at that time making the coffin, people will
laugh at you.”(Mrs. M., 71 y/o); and “These things
[death related] should be prepared. …Prepare it early.
Whenever it comes, it is ok …” (Mrs. O., 59 y/o).
Instead of relying on others (their children/family or
the community), they chose to take action to ensure a
good death, and preparations were described as start-
ing early when the individual is still healthy and able
to make the objects and symbols that should ensure
their transition to the afterlife (i.e., coffin and shrouds
for burial clothing). Mrs. O. (59 y/o) and her husband
made their coffins years ago prior to her husband’s
illness, while Mr. and Mrs. B. (respectively, 79 and
80 y/o) made their coffins twice because a fire
destroyed the ones made in their early sixties. Mrs. B.
commented that “If the coffins were made, …[her
son] won’t need to worry about it …he would know
it is prepared,”while Mr. F. (76 y/o) said: “When you
are really old and the heaven wants you, people could
just put you [your body] into it …It is good to put
the body into a coffin [already made].”
The elderly seemingly derived pride knowing they
have prepared for their own death-related rituals and
could lessen their children’s burdens at the time of
death. Mrs. M. (71 y/o) proudly talked about having
done most of the preparations for her husband’s and
her own funerals, because when death comes, “the
sons and daughters would not know what to do and
where to begin. They are too young to know these
things …The wood for making the coffin was
brought by myself. I made it. I paid for it without
using the children’s money.”Other participants fear
that if they do not make preparations, their unfilial
children could further ruin the family’s reputation by
not doing what is expected.
Death-related objects and symbols are culturally
determined and dependent on the availability of things
such as life insurance, signing wills, or finding burial
sites (Chan & Yau, 2010; Kastenbaum, 2012; Pinquart
& Sorensen, 2002; Robbins, 1991). For the rural elders,
death preparation depends on the making coffins and
shrouds by oneself, having sons and grandsons present
at one’s death bed, or knowing the means to commit
suicide. Rural elders also take action distributing per-
sonal possessions early. Mrs. M. (71 y/o) asked her
grandson to take something to his home because: “In
my mind, I am thinking leaving something to the next
generation will be a reminder of me.”Ensuring inter-
generational links through early distribution of mater-
ial goods is yet another way to prepare for a good
death and generate a feeling of continuation with the
next generation following death. Intergenerational
connectivity gives a sense that one will be remembered
in a positive way, leaving legacies for the next gener-
ation (Firestone & Catlett, 2009), and having a good
death and appropriate funeral ceremony. Death prep-
aration is pertinent to establish good connections with
future generations and for being worshiped well in the
afterlife (Yick & Gupta, 2002).
A preliminary model of death preparation
Our preliminary death preparation model explicates
how rural elders perceive death as instrumental in
their conversations about death, describe their wish
for dying well, take action making objects and sym-
bols, and aspire for honor and worship in the afterlife
(Figure 1), and this is similar to Kastenbaum’s(2012)
DEATH STUDIES 7
death system. Family and the family honor provide
the context for death preparation and this is not dif-
ferent from elders elsewhere (B
elanger, 2002; Carr,
2003; Chan & Yau, 2010; Pinquart & Sorensen, 2002).
However, for the rural Chinese participants we inter-
viewed, death preparation is also instrumental in pro-
tecting the family from humiliation and dishonor, for
entering the afterlife, and becoming a worshiped
ancestor who died well. Dying well is preferred to be
becoming a wandering ghost who committed suicide.
Good dying seems to be a universal theme in death
preparation across cultures where people take action
to minimize death anxiety (B
elanger, 2002; Chan &
Yau, 2010; Mullick et al., 2013).
Conversing about death and making death-related
objects and symbols are implied in the death system
proposed by Kastenbaum (2012) and others (e.g.,
Chan & Yau, 2010; Pinquart & Sorensen, 2002;
Robbins, 1991) and were instrumental to the rural eld-
ers’death preparation system. As a function of remin-
iscence (Haj & Antoine, 2016; Webster et al., 2010),
conversing about death and death preparation also
promotes death acceptance. Contrary to common
belief, the elders we interviewed eagerly talked about
death and their preparations for a good death, also
contemplating the prospects of speaking with their
children when they around. The distress of having
supposedly unfilial children or children who live too
far away to take proper care of their ageing parents
emerged in conversations of contemplating suicide –
an unnatural death that could deprive them from an
afterlife and a relatively unique form of death prepar-
ation for rural Chinese elders (Liu & Wang, 2013).
Conclusion
We found that rural Chinese elders living in a village
in southern China openly talked about death and
actively prepared for their own death. The participants
believed that death is natural, destined to happen and
a transition to an afterlife. Preparing for death is a
process integrated with family members’cooperation,
especially the oldest son, and planning for a good
death is important to become a worshiped ancestor in
afterlife. Chinese rural elders commit to death prepar-
ation somewhat differently from their urban counter-
parts. Yet, the preparing for death in order to feel
peace about their living, death and afterlife, and by
balancing personal and family-based benefits is shared
in both rural and urban areas. The model we propose
is an attempt to systematically capture death prepar-
ation as instrumental to the elements involved in rural
elders’end-of-life experiences. Chinese elders, both
rural and urban, prepare for death. They share com-
monalities talking about death and aspiring for having
a good death, although they differ in the actual proc-
esses of preparing for death.
There are some limitations in the study worth men-
tioning. The findings of this study should be under-
stood in the local context of the community within
which we conducted the narrative data collection –it
is locally specific and not necessarily applicable to all
rural Chinese elders. Nonetheless, although not the
aim of a qualitative study to generalize, we present the
rich descriptions about death preparation adding to a
greater understanding of how the social–cultural
scripts in rural communities could inform the context
and content of death preparation. Additionally, there
could be some participant-recruitment bias as we
could only collect data from the elders who were will-
ing to share their stories with us. Another challenge is
related to the transcription of local dialect and transla-
tion of the field texts. We interviewed the participants
using local dialect, transcribed the audio-taped inter-
views in Mandarin, and translated the transcripts into
English. Although we collaborated to reduce errors of
interpretation, working with translated texts always
involves the possibility of losing some of the nuanced
meanings embedded in participants’colloquial lan-
guage used during the interview.
Further research is necessary to broaden our under-
standing of the death preparation system among rural
Chinese elderly and to verify the preliminary model
proposed here. We also propose that death prepar-
ation should be taken into consideration when revi-
sing policies regarding elderly welfare. Our study
revealed that the death preparation system is of par-
ticular importance to rural elderly, and we believe that
policy revisions might be necessary explicating the
need for family members of rural elders to be edu-
cated about their parents’end-of-life needs. Social
services in rural areas should also consider provide
advanced care planning for people living away from
major cities and the primary care of family members.
Considering that the suicide rate among rural elders is
almost five times higher than that for urban elders (Li,
Xiao, & Xiao, 2009), further investigation into how
rural elders perceive suicide as preferable to dying
without family (or sons) to support one in the final
days is necessary. These elders might need other forms
of assistance so that they could at least have the
option of choosing a good death instead. Finally, we
urge caregivers, social workers, elderly centers, and
health institutions to note the importance of death
preparation for the elderly in deep rural areas and to
be more easily accessible where the need is highest.
8Y. LIU AND G. J. VAN SCHALKWYK
Acknowledgments
The authors wish to thank the participants for their gener-
osity sharing their stories.
Funding
The study was funded by Universidade de Macau. This
work was supported by the University of Macau [grant
number MYRG2015-00191-FSS] and awarded to Gertina J.
van Schalkwyk.
References
B
elanger, D. (2002). Son preference in a rural village in
North Vietnam. Studies in Family Planning,33, 321–334.
doi:10.1111/j.1728-4465.2002.00321.x
Braun, V., & Clarke, V. (2006). Using thematic analysis in
psychology. Qualitative Research in Psychology,3,77–101.
doi:10.1191/1478088706qp063oa
Carr, D. (2003). A “good death”for whom? Quality of
spouse’s death and psychological distress among older
widowed persons. Journal of Health and Social Behavior,
44, 215–232. doi:10.2307/1519809
Corr, C. A. (1992). A task-based approach to coping with
dying. OMEGA –Journal of Death and Dying,24,81–94.
doi:10.2190/CNNF-CX1P-BFXU-GGN4
Chan, C. K., & Yau, M. K. (2010). Death preparation among
the ethnic Chinese well-elderly in Singapore: An explora-
tory study. OMEGA –Journal of Death and Dying,60,
225–239. doi:10.2190/om.60.3.b
Chan, T. H., Chan, F. M., Tin, A. F., Chow, A. Y., & Chan,
C. L. (2007). Death preparation and anxiety: A survey in
Hong Kong. OMEGA –Journal of Death and Dying,54,
67–78. doi:10.2190/6478-6572-V704-1545
Chan,W.C.H.,Tse,H.S.,&Chan,T.H.Y.(2006).Whatis
a good death: Bridging the gap between research and inter-
vention. In C. L. W Chan & A. Y. M Chow (Eds.), Death,
dying and bereavement: A Hong Kong Chinese experience
(pp. 127–138). Hong Kong: Hong Kong University Press.
Chen, S., Jin, Y., & Guo, S. (2006). A literature review on
research on death attitudes in western countries. Social
Sciences Abroad,1,65–68. (in Chinese)
Chow, A. Y. M., & Chan, C. L. W. (2006). Introduction. In
C. L. W. Chan & A. Y. M. Chow (Eds.), Death, dying
and bereavement: A Hong Kong Chinese experience
(pp. 93–103). Hong Kong: Hong Kong University Press.
Cui, W., Wang, J., & Zhang, G. (2011). An overview of rural
Chinese empty-nest elders’mental health research.
Sichuan Mental Health,24, 256–258. (in Chinese)
Firestone, R., & Catlett, J. (2009). Beyond death anxiety:
Achieving life-affirming death awareness. New York, NY:
Springer Publishing Company.
Gielen, U. P. (1997). A death on the roof of the world:
The perspectives of Tibetan Buddhism. In C. M. Parkes,
P. Laungani, & B. Young (Eds.), Death and bereavement
across cultures (pp. 72–97). London, UK: Routledge.
Haj, M. E., & Antoine, P. (2016). Death preparation and
boredom reduction as functions of reminiscence in
Alzheimer’s disease. Journal of Alzheimer’s Disease,54,
515–523. doi:10.3233/JAD-160497
Hart, B., Sainsbury, P., & Short, S. (1998). Who’s dying: a
sociological critique of the good death. Mortality,3,
11–65. doi:10.1080/713685884
Howarth, G., & Leaman, O. (2003). Encyclopedia of death
and dying. London, UK: Routledge, Taylor & Francis
Group.
Hui, V. K. Y., & Coleman, P. G. (2013). Afterlife beliefs and
ego integrity as two mediators of the relationship between
intrinsic religiosity and personal death anxiety among
older adult British Christians. Research on Aging,35,
144–162. doi:10.1177/0164027512436429
Kastenbaum, R. (2012). Death, society, and human experi-
ence (11th ed.). Boston, MA: Pearson.
Li, H., Chi, I., & Xu, L. (2013). Life satisfaction of older
Chinese adults living in rural communities. Journal of
Cross-Cultural Gerontology,28, 153–165. doi:10.1007/
s10823-013-9189-2
Li, X., Xiao, Z., & Xiao, S. (2009). Suicide among the elderly
in mainland China. Psychogeriatrics,9,62–66.
doi:10.1111/j.1479-8301.2009.00269.x
Liu, Y., & Wang, X. (2013). Suicides of the aged in rural vil-
lages of China in the cultural perspective and their
regional differences. Journal of Yunnan Normal University
(Humanities and Social Sciences), 45. 125–134. (in
Chinese)
Mak, J. M. H., & Clinton, M. (1999). Promoting a good
death: An agenda for outcomes research-a review of the
literature. Nursing Ethics,6,97–106. doi:10.1177/
096973309900600202
McAdams, D. P. (2008). The Life Story Interview. Retrieved
from http://www.sesp.northwestern.edu/docs/LifeStory
Interview.pdf
Merriam, S. B. (2009). Qualitative research: A guide to
design and implementation. San Francisco, CA: John
Wiley & Sons.
Ming-Lin, A. C., & Lang, G. S. (1998). Attitudes of Chinese
elderly people towards death: Practical implications for
social workers. Asia Pacific Journal of Social Work
and Development,8,50–63. doi:10.1080/21650993
.1998.9755778
Mjelde-Mossey, L. A., & Chan, C. L. (2007). Survey on
death and dying in Hong Kong: Attitudes, beliefs, and
preferred end-of-life care. Social Work in Health Care,45,
49–65. doi:10.1300/J010v45n01_04
Moustakas, C. (1994). Phenomenological research methods.
Thousand Oaks, CA: Sage.
Mullick, A., Martin, J., & Sallnow, L. (2013). Advance care
planning. British Medical Journal,347, f6064–f6032.
doi:10.1136/bmj.f6064
Neimeyer, R. A., & Sands, D. C. (2011). Meaning recon-
struction in bereavement: From principles to practice. In
R. A. Neimeyer, H. Winokuer, D. Harris, & G. Thornton
(Eds.), Grief and bereavement in contemporary society:
Bridging research and practice (pp. 9–22). New York, NY:
Routledge.
Neimeyer, R. A., Wittkowski, J., & Moser, R. P. (2004).
Psychological research on death attitudes: An overview
and evaluation. Death Studies,28, 309–340. doi:10.1080/
07481180490432324
Norstrand, J. A., & Xu, Q. (2012). Social capital and health
outcomes among older adults in China: The urban–rural
DEATH STUDIES 9
dimension. The Gerontologist,52, 325–334. doi:10.1093/
geront/gnr072
Pinquart, M., & Sorensen, S. (2002). Preparation for death
and preparation for care in older community-dwelling
adults. OMEGA –Journal of Death and Dying,45,69–88.
doi:10.2190/5k9j-c320-22lq-kph6
Riessman, C. (2007). Narrative methods for the human scien-
ces. Thousand Oaks, CA: Sage.
Robbins, R. A. (1991). Bugen’s coping with death scale:
Reliability and further validation. OMEGA –Journal of
Death and Dying,22, 287–299. doi:10.2190/hntd-rwrw-
y3yn-vwx1
Sit, H. Y. (2017). Exploring women’s perceptions of self-position-
ing in contemporary Chinese societies (Unpublished doctoral
dissertation). Taipa, Macao (SAR): University of Macau.
Webster, J. D., Bohlmeijer, E. T., & Westerhof, G. J. (2010).
Mapping the future of reminiscence: A conceptual guide
for research and practice. Research on Aging,32, 527–564.
doi:10.1177/0164027510364122
Wong, P. T., Reker, G. T., & Gesser, G. (1994). Death
attitude profile-revised: A multidimensional measure of
attitudes toward death. In R. A. Neimeyer (Ed.),
Death anxiety handbook: Research, instrumentation, and
application (pp. 121–148). Washington, DC: Taylor &
Francis.
Yalom, I. D. (1980). Existential psychotherapy. New York,
NY: Basic Books.
Yalom, I. D. (2008). Staring at the sun: Overcoming the ter-
ror of death. The Humanistic Psychologist,36, 283–297.
doi:10.1080/08873260802350006
Yick, A. G., & Gupta, R. (2002). Chinese cultural
dimensions of death, dying, and bereavement:
Focus group findings. Journal of Cultural Diversity,9,
32–42.
10 Y. LIU AND G. J. VAN SCHALKWYK
