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The Ojo and Death Project Study Tour in Taiwan

National Taiwan University Palliative Care Unit and Hospice
Taipei City

NEW! see an excerpt of a more comprehensive report on NTUH and the Taiwan Association of Clinical Buddhist Studies that will appear in our forthcoming book The Vihara of Compassion, published by Wisdom Books in late 2012

An interview with Director Dr. Chien-An Yao



The NTU Hospice is the first established in Taiwan in 1995 with 17 beds predominantly for cancer patients (at or after stage 4; liver cancer and lung cancer are most common). ALS patients are also admitted but these are very few, only 1%. Limitation to these two diseases is because national insurance will only cover these types of illnesses.
The patient's family must sign a waver for resucitation upon entry, because they donft perform resuscitation at the hospice. This is the role of the family and not the patient since, like Japanese, many Taiwanese donft believe in the informed consent of the patient and so the patient may not really know they are dying when they are first admitted to the hospice. The 17 beds are usually full. 17 days is the average stay and this is partly because of the misconception by people of what palliative care means. There is still fear and stigma behind being admitted to a hospice, so many do not want to come any earlier. The senior doctors who established this hospice received a strong influence from the hospice tradition of the U.K. after visiting and learning at St. Christopherfs hospice with Cecily Saunders. They have also been influence by hospice care in Hong Kong and Singapore, which is also influenced by the U.K.

They feel there are 3 things needed for death preparation: 1) awareness that death is coming so you need to accept it, 2) awareness that death is the common path or way for all people and so you should seek a coping method, 3) develop onefs inner power Ms (Jp. shingangyo, lit. faith-vow-practice) a special Buddhist term. They also perform an assessment of a ggood deathh using 5 criteria: 1) freedom from pain, 2) at peace [with God], 3) presence of family, 4) mental awareness, 5) treatment choices followed.  Other aspects of this assessment are: 1) understanding oneself is dying and that dying is approaching, 2) peacefully accepting it, 3) having proper preparation, 4) good timing or not of death, 5) feeling comforted or distressed in the last week.

The core principle of the NTU hospice is TEAM CARE amongst the doctors, nurses, social workers, psychiatrists and clinical chaplains. Every Tuesday morning for 2 hours the entire team goes on rounds together to all 17 beds. Once a month they hold a video conference with the other hospices in Taiwan. They present case reports like truth telling and informed consent, symptom control, spiritual care, and other success and failure stories.

MEDICAL STAFF: There are two senior doctors (out of a pool of 14), 2-3 3rd year residents, and 17 nurses – 1 per bed by national regulation. For the residents, there is a 2 month residency and 1 month home care residency.

CLINICIAL PSYCHOLOGISTS: There are 3-4 clinical psychologists who are still students, and they shift every six months. There is one student per 3-4 patients. They do psychological assessments, give advice to the team on care, and deal with patient depression and anxiety, etc. They will seek help from their supervisor who may come to the hospice to help.

ART THERAPISTS: There are 2 who do bereavement support and help to the families as well as the patients, for example supporting an elder sister who was feeling neglected by her parents because they were attended to the younger sister who was dying. The art therapists may guide patients to copying pictures of Kannon Bodhisattva. The patients may add their thoughts to these pictures and actually speak to Kannon through them. There is also the sense of traditional Buddhist making merit from copying such pictures.

VOLUNTEERS: There is a base of 50 who work in shifts of 5 in the morning and 5 in the afternoon. They assist the medical professionals, cook food (especiallyV Jp. yakuzen which includes Chinese medicine and/or medicinal herb), read the patients books, and help patients with special requests like if they want to see someone, or even visit somewhere like the beach for the last time.

BUDDHIST CHAPLAINS: Since 1998 the NTU Hospice in cooperation with the Buddhist Lotus Hospice Care Foundation and the Yi-Ju Sanctuary Hospice Care Association has endeavored to develop an indigenous spiritual care model for terminal cancer patients and to train clinical Buddhist chaplains who, upon graduation, are being referred to palliative wards throughout Taiwan (at present almost 30 such units). The Foundation does the prior training and supports them with small stipends for transportation. However, as they are monks are nuns, it is considered that they should work without payment. They first are interviewed about their motivation and education level and then are selected for the program. They have 3 months training in primary care with 6-7 patients, and are also trained by the Lotus Foundation in other medical aspects and how to deal with the dying, such as how to touch the bodies of the sick. They perform spiritual assessments to decide about spiritual care and whether the person should die at home or in the hospice at NTU. They also discuss the potential of using rituals and Help Chant Groups O who chant the nenbutsu for 8 hours after death. They have a base of 17-20 chaplains with 2-3 on call at any one time. The group is led by Ven. Hwei-Minb@twho received a PhD at Tokyo University. Once a month the whole group goes on rounds. This work is being expanded through the recent establishment in 2007 of the Taiwan Association of Clinical Buddhist Studies (sՏś{) . Besides training and supporting Buddhist clinical chaplains, the group also seeks to educate the larger public through public seminars on death and dying issues, especially as many Taiwanese may fear clinical chaplains because they may view them as harbingers of death. For more details on their work, visit there homepage here.

AT DEATH



The image above is a room for prayer, chanting, meditation, and spiritual counseling for patients within the hospice. The room is also used in a patient's final moments. In general, Taiwanese Buddhists will practice like Japanese Pure Land Buddhists, chanting the name of Amida Buddha at the time of death and using a large picture of Amida Coming to Welcome (}} Jp. rai-kozu) to assist the dying person.



There is a special morgue in the basement of the hospital called the "Room for Birth (in the Pure Land)" ( Jp. ojo-shitsu) for any patient in the hospital where the body can remain untouched for 8 hours, as in traditional Buddhist practice, and family, monks and nuns, and medical staff can chant Amida Buddhafs name, the nenbutsu.



NTU Hospice does bereavement support for the family after death with gatherings at the hospice. They also hold group memorial services and the medical college preforms a memorial services every April for people who have donated their bodies for research or organ transplants. The families and monks are invited to attend as well.

SPECIAL ACTIVITIES



Volunteers take patients for special last wishes. Promoting skinship. Concert in the hospice.





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