A poster on the street reveals a striking question: “How do you prepare for death?” The passersby can’t resist but to stop and stare at it, forcing them to think about their meaning in life. In the afternoon, people in the corner café are enjoying a memorial concert; some bereaved family members just left work and are heading to a bereavement and grief themed art show in the cultural center; experts in the acute illness medical conference’s social forum are discussing life and death issues and reviewing the current policies; and caregivers are having in-depth conversations with the elderly in the community alley.
The international Charter for Compassion has already been translated
into more than 30 languages, and is becoming a global trend.
This community is filled with books, architecture, music, and etc. that carry friendly, compassionate and intriguing messages about life and death. More importantly, in this compassionate city, dying, death and grief are no longer taboos because these people see dying and death differently and understand how to better manage death.
This is what the “Compassionate Cities” will look like in the future. In 2017’s Asia Pacific Hospice Conference in Singapore, the concept of “Compassionate Cities” has been advocated to the public, inviting every country to promote palliative care systematically into their community network, and also to work with counterparts in public health to build up partnerships to care for one another. Furthermore, they must include learning how to face death as a necessary link when promoting health in their countries.
Caring for death is implementing “Compassionate Cities”
Prof. Allan Kellehear, from the University of Bradford - UK, has devoted himself to advocating Compassionate Cities; and he elaborates that Compassionate Cities refer to the entire community as it endeavors to facilitate citizens’ health and welfare in a systematical and comprehensive way. These “cities” are part of an interconnected network in a boarder sense. The journey of human life is a continuum, and thus, even the end of life should be seen as a healthy stage of life. As such, caring at one’s end of life should be as ordinary as any other part of our daily lives and be everyone’s responsibility.
Compassionate Cities is vital to public health policy
The theoretical characteristics of Compassionate Cities as described by Prof. Kellehear draw on the principles of Healthy Cities and are outlined below.
A Compassionate City:
- Has local health policies that recognizes compassion as an ethical imperative.
- Meets the special needs of its aged, those living with life threatening illnesses, and those living with loss.
- Has a strong commitment to social and cultural differences.
- Involves grief and palliative care services in local government policy and planning.
- Offers its inhabitants access to wider variety of supportive experiences, interactions and communication.
- Promotes and celebrates reconciliation with indigenous peoples and memory of other important community losses.
- Provides easy access to grief and palliative care services. (Kellehear 2005 p.46)
In the seventeen Sustainable Development Goals set forth by the
United Nations in 2016, it was emphasized for the first time,
that in order to experience transformation in overall social thinking
and economic model, the primary focus should no longer be on just
economic growth. Rather, we must assimilate issues related to environmental
protection and social inclusion into our policies. (Source of diagram: UN Website)
Palliative and hospice care is a service dedicated to end of life care, which is not limited to the elderly but all end of life patients; as such, it should be considered and promoted as a community health issue. Palliative and hospice care should also be included in local public health for end of life; and death should not merely belong to the medical sphere, but also to the social realm that affects everyone.
Prof. Kellehear stresses that as the society is aging rapidly with limited resources, many cannot die at the place of their desire. He also points out that the overexposed fear of death also impedes us from knowing the death we might wish for. This means we must explore a new method to manage death. In Prof. Kellehear’s own words, systematic development of Compassionate Cities will require aid from public health to encourage the mutual caring partnership:
“Those of us in palliative care… need to learn and be supported by those in public health who understand and have practical experience with community development, health promotion, policy reform, and social and political change.”(A. Kellehear & L. Sallnow, 2012)
Change how death is managed and infuse more compassion
The goal of the Compassionate Cities Movement is to change the way on how death is managed, and also to encourage people to participate in community affairs as they promote the concept of compassion. This concept has to also transcend the care to the end of life, and extend to public health and society to cope with death. When building the Compassionate Cities atmosphere, initiating Conversations for Life is the element that should be targeted. Academic conferences, the media, and social events can all attract the participation of public health, health care, and volunteer communities, so that the community workers and healthcare professionals can assist the flow of Conversations for Life of family stories and life experiences. Trained healthcare professionals and volunteers can help patients and families to reveal their wishes through the Conversation, and to further support and achieve these wishes.
The Conversations for Life reflects the vision of Compassionate Cities: to focus on life, health, and death in advance. The dialogue of life generates the energy for a community to develop and enhance connection. The facilitators of Conversations for Life work with health, end of life care, social care, religion or volunteer groups, and plan strategy based on the informed perspective while being allied with community groups to provide companionship. It all starts with the community and later hopes to proceed to a higher level transformation.
Below are the examples of Compassionate Cities development results in the UK:
- Partnership working across six localities with the Cheshire and Merseyside Clinical Networks, Palliative and End of Life Care Network, local hospice, voluntary leads and community organizations. Conversations for Life worked to support a community engagement process across the locality, leading to the development of community champions and community-led plans.
- A Public Health Initiative around Advance Care Conversations and End of Life Care.
- Multi-disciplinary training courses and consensus meeting focus on healthcare professionals who work with chronic conditions including dementia, renal, cardiac and stroke, and mental health.
- Development of resources, including films that engage the stories of local people, hold workshops, facilitate training (raising awareness around advance care/end of life conversations), and publicity materials which can be adapted to suit the needs of the groups or organizations undertaking organizational and community initiatives.
- Establishment of an independent Community Interest Company to seek funding, sponsorships and grants, individual donations and corporate business partners. Allow business partners to develop products, training and consultation system to support relevant costs.
(Excerpted and re-edited from “An Overview of Compassionate Communities in England”)
Redefining Palliative Care
Briefly speaking, Compassionate Cities is an ideal concept to facilitate and build a close relationship of its people in a positive and healthy way. That way, people can talk not only about health, but also about death without any awkwardness. No matter in the schools, workplaces, playgrounds or media, no matter if one is healthy, sick, old or young, the topic of death can always be discussed with ease and comfort by more people so as to better understand and accept it.
In hospitals, the palliative and hospice ward is like a library of life itself, not only emphasizing the psychosocial aspect, but also stressing the sociopsychological perspective. The elderly, who do not wish to choose hospitals as their life’s terminal station, can express their willingness in advance in order to receive support from their families and make arrangements beforehand. By eliminating emergency medical treatment, it reinforces social care to eventually fulfill their wishes to dying well at homes.
Medical care providers can also start with the concept of Compassionate Hospitals, encouraging and allowing discussions about acute diseases and death more openly. For example, through the means of life story post cards, patients and family members can be encouraged to talk about life, disease, grief, and death. As clinical staff receives relevant palliative cognition training and learns how to hold end of life family consulting meetings, they are more able to perform the role of coordinating, educating, supporting, consulting and healing. Whatever the case, it is important to remind team members to care for end of life patients whether they are inpatient, outpatient, or emergency patients.
With the concept of Compassionate Cities, palliative and hospice care will be redefined. Professionals from palliative teams will be working with the community, and also providing relevant information and promoting events to raise people’s awareness to prepare for life’s end. They will also be offering end of life care for those who are about to step off the train of life. All in all, Compassionate Cities is not just a government policy, but can be pursued and achieved by everyone.
The Charter for Compassion was launched in 2008.
Currently, over seventy cities in nearly 50 nations
have joined in the effort to campaign for the concept
of compassionate cities. (Data from the Charter for Compassion website)