He would always spend years recording his life or death moments in the ICU from behind the camera. But everything changed when he went through three severe episodes of acute pancreatitis in a year.
“It was all self-harm — alcohol, social events,” Yu said. “But it made me realize that death is one destination that we all share. I wanted to understand that and choose the way I face it.”
Last month, Yu joined the Chinese people who made a living through an online platform and officially document their end-of-life hopes. He chose to refrain from CPR, mechanical ventilation, and tube feeding if his condition was deemed irreversible.
As China developed, life expectancy steadily rose. In 2024, it reached approximately 79 years, 2024, the highest in developing countries. While many older adults are now living longer and healthier lives, the rise in chronic illness and end-of-life challenges encourage a deeper reflection on how to age and die with dignity.
In this changing landscape, end-of-life plans slowly take part in public conversations. Although once considered taboo, the living will and the command for advancement has acquired status, individuals feel more clearly the greater control and the ultimate wish of loved ones to their families.
Yu is part of the demographic driving this change. He is an educated urban technology-savvy adult age between 30 and 59. This age group accounts for two thirds of more than 60,000 people who have signed their will to live with the Beijing Living Promotion Association, known since 2010 as a platform of choice and dignity.
“At our age, the most obvious sign is that there will be fewer wedding invitations and more funeral notices,” he said. “I’ve seen too many people suffer unnecessary on their last days, like my grandfather, who was bedridden for eight years. It wasn’t life. It was a long period of pain.”
Almost 70% of Chinese people who sign a will that lives with the association have university degrees, most live in advanced cities such as Beijing, Shanghai, and Shenzhen.
Growth was initially rapid, peaking at around 15,000 people a year six years ago, but this has slowed down. According to Wang Bo, executive director of the association, this is not due to decline in profits, but the emergence of more channels for writing wills, such as hospitals, civic groups, and notarized agencies.
“The public is growing awareness,” the king said. “When we first started, no one responded to the information we shared on WeChat. But now, even high school students are joining the volunteer team.”
Still, progress clashes with tradition.
In China, the cultural norms surrounding death remain strong. It is often avoided, as it is viewed as inviolable. Treatments that extend into life can, no matter how wasteful, can be considered unfair. Families often insist on positive intervention in emotional closure or fear of judgment.
Qin Yuan, a doctor at the Palliative Care Center at Beijing Heidian Hospital, often sees this tension. “People believe that as long as their older relatives are alive, their families are the whole,” she explained. “They are also worried that they will be judged too early to ‘give up’. ”
To navigate this, her team holds family meetings to match patients’ wishes to their families. “It’s a daily negotiation,” she said.
And policies are beginning to reflect changing attitudes.
In 2023, Shenzhen became the first Chinese city to legally recognize living wills, allowing its residents to refuse invasive treatment at the end of their lives.
The move has sparked unexpected interest, and the notary’s office is reporting an increase in people trying to formalize their wishes.
“Young people and childless couples are increasingly seeking notarization,” said Li Suimei, Notary, Deep Shenzhen. “They are deeply interested in maintaining dignity in the last moments.”
With China’s population of over 310 million people over the age of 60, the government is expanding its palliative care services as part of a broader strategy to meet the diverse needs of older adults.
China’s hospice units increased from 510 in 2020 to 4,259 in 2022, with pilot facilities reaching 185 cities and counties. However, access is uneven, especially in the undeveloped western regions. By 2025, the government aims to establish at least one palliative care ward in all pilot areas, ensuring compensation in both urban and rural communities.
Other momentum is being built. In 2024, the national political advisor proposed expanding education and policy support. Advocates want advance orders linked to health IDs and ensure that people’s wishes follow them to hospitals.
This shift reflects global trends. The US is moving from a static living will to an ongoing progressive care plan (ACP), while China is adapting a similar model.
Wang is intended for ACP. This will be an important promotional focus for her association in the future as a tool to translate personal preferences into practical medical plans.
She said the association will use big data to inform its policy and expand its outreach through video sharing and streaming platforms such as Douyin and Bilibili.
Still, cultural resistance remains.
“Some people drive us away, as if talking about death would come sooner,” said Xiang Qiaozhen, palliative care nurse and volunteer advocate at Zhijiang. “However, waiting until the end often means missing out on the opportunity to have a conversation.”
She doesn’t make a living on her own, but her daughter knows her wishes. “One day she told me, “That quiet understanding is something we want to build.”
Yu Bo was also faced with a pushback. After sharing his decision to make a living through his WeChat account, friends flooded him with calls, assuming he was terminally ill. “They couldn’t believe that I made that choice just to prepare,” he said.
“The discomfort about our deaths is mostly in our cultural DNA,” Yu recalls. “We fear it, avoid it, and rarely argue it. But it should be our own right to choose how we leave this world.”
Nevertheless, he remains hopeful. “I believe more people will choose the same path,” he said. “I want to tell their stories through films. Maybe we learn to talk about death – not live in it, but live smarter for it.”
MNA/