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Bridging Silence with Compassion: End-of-Life Conversations in Chinese American Families




When Sandy Chen Stokes visited her father in Taiwan, he was already in the ICU—hooked up to machines, unresponsive, and unable to speak for himself. There had never been a conversation about what he would’ve wanted. No DNR. No advance directive. And at that time, Taiwan had no laws in place to honor such choices anyway. Sandy, a nurse in the U.S., recognized the heartbreaking gap: no one had prepared for this. Her father remained in the ICU for over a year. That experience lit a fire in her. She returned to California and founded the Chinese American Coalition for Compassionate Care (CACC), determined to help others avoid that kind of painful uncertainty. 


In many Chinese American families, end-of-life conversations remain rare and emotionally charged. Deep-rooted cultural beliefs, fear of bringing “bad luck,” and a sense of respecting one's elders can make even the idea of planning feel taboo. Add in intergenerational gaps, shifting caregiving roles, and language barriers—and you have a perfect storm for silence. 


But that silence comes at a cost. 


Without these conversations, families are left guessing about their loved ones’ wishes—sometimes long after they’re gone. Siblings argue. Guilt lingers. Opportunities for comfort, closure, and peace are lost. As Sandy shared, “We all want to do the right thing, but how can we if no one tells us what that is?” 


The good news is that change is possible—and it’s already happening. CACC has been training volunteers, creating bilingual resources, and hosting “Heart to Heart Cafés” where families can gently explore these topics together. Their Heart to Heart Cards—adapted from the Go Wish cards—use familiar playing card formats to invite questions like: Who do you want making decisions for you? Do you want music playing near the end? Would you like your pet with you? 


These small, thoughtful tools are opening doors where words once failed. 


And for those of us who serve Chinese American families—whether as doulas, doctors, nurses, or community members—our role is vital. We don’t need to speak the language to build trust. Simple gestures like offering to remove our shoes when we visit a person's home, asking about spiritual needs, or respecting family structure can go a long way. Most of all, we must listen. As Sandy said, “Once people feel seen and safe, they’ll share.” 

If you’re part of a Chinese American family, consider starting small. Share a memory. Ask a parent if they’ve ever thought about what would bring them comfort in their final days. You don’t need all the answers. Just the courage to begin. 


Because talking about death isn’t giving up—it’s showing up. For your loved ones. For yourself. 


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