Chronic living and delayed death in chinese eldercare institutions

Abstract

In urban China, demographic shifts, medical interventions, and technological advancements are reshaping how, when, and where elders live and die. Within institutions, end-of-life interventions may stave off death, but have little to offer those who are saved but not cured. Meanwhile, these end-of-life encounters are unfolding within a larger caregiving landscape that is itself in transition. Increased migration, urbanization, women’s employment rates, and access to medical services are radically altering caregiving arrangements. In particular, sharp declines in fertility have sapped family-based caregiving resources and put enormous pressure on medical institutions. Although China is just beginning to feel the effects of rapid population aging, demand for end-of-life institutional care has already outstripped supply. The few palliative care wards that exist routinely turn away patients, admitting only those whose end is predictably soon. In the process, dying becomes a diagnosis, complicated by insurance regulations, local bioethics, and limited resources. For those cut off from both curative and palliative care, life itself turns pathological, and they find themselves suspended in a state of “chronic living.”.