A Renewed Positive Perspective on Death through the ENABLE Project: Society Takes a More Active Role in Facing and Preparing for Mortality

Death is an inevitable part of life. When death occurs in a family, every individual member is affected psychologically, physically, spiritually and socially. Yet, we do not talk about death nor do we prepare for it. The lack of knowledge as well as the lack of preparation for our own death or the death of our loved ones inevitably adds more pain and sufferance to the death, dying and bereavement process to both the deceased as well as the bereaved.

The Centre on Behavioral Health (CBH) of The University of Hong Kong established an Empowerment Network for Adjustment to Bereavement and Loss in End-of-life (ENABLE) in 2006, which is a project funded by The Hong Kong Jockey Club Charities Trust. Through a societal-wide campaign which serves to educate the general public on effective death preparation as well as to promote enhanced adjustment to bereavement and loss, we believe that life can become much more beautiful and fulfilling, while death can be peaceful and at the same time manifest a blissful sense of life completion.

The mission of the ENABLE is to:

• Promote public awareness on death, dying and bereavement;
• Facilitate the elderly population, people with chronic and terminal illnesses as well as their families members in preparing for death, dying and bereavement; and
• Develop overall competence of professionals in supporting dying patients and bereaved persons.

Since its inauguration 3 years ago and now nearing its completion, the ENABLE project has trained up 2,000 frontline practitioners to deliver death education workshops and seminars to more than 73,600 members of the general public. Moreover, the ENABLE Alliance has attracted the participation of 50 hospital groups, community service agencies and NGOs, who have worked collaboratively and in harmony to promote death education in Hong Kong.

Key research findings form ENABLE project

1, The death education workshops and professional training modules reduced the death-related anxiety

Findings from a series of vigorous efficacy studies with nearly 3,000 respondents show that, the ENABLE project together with its death education workshop and professional training modules have helped to increase the knowledge base on death and dying for healthcare and allied health professionals, patients, elders and their families. Specifically, the project was successful in relieving participants' death-related anxiety, increasing their comfort in talking about death while supporting positive attitude and behavioral change towards death and dying.

2, There are attitudinal changes on death taboo in the local community compared with the figures in year 2007

Furthermore, a 3-year prospective cohort study that looked at the attitudinal changes on death among 1,475 Chinese respondents in Hong Kong also reveals very promising results. Specifically between 2007 and 2010, the percentage of people who believe talking about death and seeing a dead body or coffin would bring bad luck have noticeably decreased; while being in social contact with or visiting a recently bereaved family is less seen as a curse but more of an act of care and compassion.

3, Middle-aged adults and elderly people are now more ready to initiate death preparation

Results from the cohort study also show that the percentage of middle-age adults and elderly adults who have taken initiatives in preparing for their own death has risen significantly within the last 3 years. Compared to 2007, 20%-30% more middle-age and elderly adults have purchased life insurance in 2010, 10%-25% individuals more have set up a will, 6%-20% more individuals have purchased burial plots, while 15%-20% more individuals have opt for organ donations.

Professor Cecilia Chan, project director, said that it is truly heartening to see that the general public has endorsed a more positive outlook when dealing with death related issues. Death has become less of a cultural taboo in Hong Kong, while people are much more willing to accept the fact that death is a natural part of life and therefore have more capacity to face their own deaths and those of their loved ones.

Mr. Andy Ho, head researcher, said that it is indeed encouraging to see the positive attitudinal and behavioral change among the middle-age, and especially the old-age population; however, much more work needs to be done with younger age groups. He pointed out that death is still heavily perceived as a taboo topic among young people in Hong Kong. Not only are they afraid of death, they are also uncertain about life, often feeling lost and powerless towards life changes and adversities.

The way ahead

Professor Chan added that the lack of life and death education curriculum in the Hong Kong school system is one of the biggest hurdles in teaching young people about the significances of death and the meaning of life. Compared to young children in Taiwan or other Western countries who learn about life and death issues through a progressive curriculum of creative and experiential learning that spans from kindergarten to secondary school, Hong Kong children receive little attention in this regard.

Perhaps the recent upsurge in media coverage as well as the evident increase in newspaper articles that focus on death-related issues is a promising step in the right direction as they provide a platform for open dialogue among the general public.

But what's more important is the expansion of life and death education that target a wider spectrum of audiences, especially those directed at the younger generations. It is of paramount importance to amplify the voices of young people who fear death while feeling loss and despair in a changing world filled with chaos and adversities. This can only be achieved through a comprehensive programme of research and services that bring together the specific needs of different cohorts for formulating strategies and action plans that serve to enhance public awareness, facilitate professional training, expand service provisions, and ultimately greater advocacy to eliminate the oppression of death among the youth of Hong Kong.

The official website of the ENABLE project is at: http://www.enable.hk.