Seeing Dignity Differently
What Chinese Perspectives Teach Us About Palliative Care
Chinese perspectives on dignity highlighted in new publication led by Wenjing Yan
Seeing Dignity Differently
At Te Ārai, our work begins with a simple but pressing question: whose experiences shape what we know about palliative care. And whose are missing?
This question sits at the heart of an integrative review led by Wenjing Yan as part of her PhD. Drawing together studies of patients’ lived experiences and family perspectives across cultures, Wenjing set out to understand what dignity actually means at the end of life and how it is experienced in practice.
The answer is as important as it is challenging: dignity is not universal. And this becomes especially clear when we look closely at Chinese perspectives.
The Limits of a Dominant Model
Much of the palliative care evidence base reflects a particular understanding of dignity; one grounded in autonomy, independence, and individual choice.
In this model, dignity is preserved when patients are fully informed, able to make decisions, and retain control for as long as possible. These elements matter, but they are not the whole story.
Dignity as Relational
In Chinese and other collectivist contexts, dignity is not centred on the individual alone. It is relational, rooted in family roles, and interconnectedness.
Dignity is sustained through being part of a family, fulfilling responsibilities, and maintaining harmony. Personhood is inseparable from relationships.
Families at the Centre
Families are central to how dignity is enacted. Decision-making is often collective, communication may be mediated, and protecting the patient is a shared responsibility.
The Weight of Not Being a Burden
For many Chinese patients, dignity is tied to not being a burden. Concerns about dependency, finances, and social standing can shape how dignity is experienced.
Filial Piety and Family Ethics
Filial piety shapes dignity in end-of-life care. Children are expected to stay involved, provide care, and seek treatment as part of their duty. This often leads families to favor life-prolonging interventions, while withdrawing treatment may feel morally wrong or disrespectful.
Indirect Communication and “Protective Concealment”
In many Chinese contexts, families may ask doctors to hide a terminal diagnosis to protect the patient and maintain hope. This is often seen as a compassionate act. However, limited disclosure can prevent patients from joining decisions, preparing for death, and expressing final wishes.
Navigating Cultural Worlds
In Aotearoa New Zealand, Chinese patients often navigate between relational cultural values and individualist healthcare systems. Dignity is negotiated across these worlds.
Patients may be expected to make decisions alone, while families feel responsible for deciding together. Doctors may expect direct truth-telling, while families may see indirectness as care.
Why This Matters
If dignity is defined narrowly, relational perspectives risk being overlooked. What is not visible in research is less likely to be visible in practice.
A Different Starting Point
We need to ask how dignity is understood in people’s lives. For many Chinese patients, it emerges in the ways family members participate in care, in how decisions are negotiated, and in the responsibilities people carry for one another at the end of life.
Returning to Visibility
Wenjing’s PhD work makes visible perspectives often marginalised in palliative care research. Dignity must be understood as multiple, relational, and culturally grounded.
Click the button below to access a full text version of Wenjing’s paper which she co-authored with her supervisors Dr Rosemary Frey, Dr Deb Raphael and Professor Merryn Gott.