At the end, to be or not to be

The cam­paign for peo­ple to write a liv­ing will while they are able is gain­ing ground in China’s fast ag­ing so­ci­ety

China Daily (Hong Kong) - - COMMENT - GAO ZHUYUAN The author is a writer with China Daily. gaozhuyuan@chi­nadaily.

Sfound­ing fa­ther Lee Kuan Yew wrote in his new book One Man’s View of the World that there is an end to ev­ery­thing and he wants his “to come as quickly and pain­lessly as pos­si­ble”, in­stead of be­ing in­ca­pac­i­tated in bed and with a tube in­serted into his nos­trils and down to his stom­ach.

The 89-year-old’s mus­ings over death are a mir­ror of the times, as ad­vances in medicine and tech­nol­ogy, such as me­chan­i­cal ven­ti­la­tors and feed­ing tubes, have not only helped to save more lives, they also at times pro­long the process of dy­ing, some­times against peo­ple’s wishes.

When the right-to-die move­ment in the West be­gan to flour­ish in the 1970s, em­pha­siz­ing pa­tients’ right to refuse life sup­port, Chi­nese peo­ple gen­er­ally died at home, ac­cept­ing death and dy­ing as part of the nat­u­ral cy­cle of life.

Nowa­days, more peo­ple in China spend their last days in hos­pi­tal, with their dy­ing process ex­tended by costly med­i­cal in­ter­ven­tions, which can nei­ther re­verse the un­der­ly­ing med­i­cal con­di­tions nor im­prove their qual­ity of life. Some ag­gres­sive end-of-life care even in­creases pa­tients’ suf­fer­ing.

This has given rise to the cru­sade for peo­ple’s right to de­cide whether to refuse life sup­port when reach­ing the ter­mi­nal phase of an ill­ness, and to­day the dis­cus­sions about the endof-life de­ci­sion to forgo or stop life sup­port are be­gin­ning to gain trac­tion in China, as the coun­try is ag­ing at an un­prece­dented rate.

China is pre­dicted to over­take Ja­pan to be­come the world’s most ag­ing so­ci­ety by 2030, and about one in four peo­ple in the coun­try will be aged 65 or above by 2050. The ag­ing pop­u­la­tion is now con­sid­ered a ma­jor rea­son for the rise in the national can­cer rate, which has climbed to an alarm­ing height, with six new can­cer pa­tients be­ing di­ag­nosed ev­ery minute. One in seven peo­ple who have can­cer will die.

A rapidly ag­ing so­ci­ety en­tails in­creased risks of ag­ing-as­so­ci­ated ill­nesses, such as can­cer, heart dis­ease and strokes. Peo­ple should think ahead about their dy­ing and whether they want life sup­port as they might not be in a po­si­tion to choose when the time comes.

There is no spe­cific law in China at present en­ti­tling peo­ple to refuse life sup­port to avoid ex­pe­ri­enc­ing a painful death. Fam­ily mem­bers gen­er­ally make the de­ci­sion, and in most cases, they try hard to get med­i­cal treat­ment that might pro­long the lives of their loved ones, even though the pa­tients might not want the treat­ment.

De­spite his re­peated re­quest for a quick exit, the writer Ba Jin was bedrid­den and hooked up to life-sus­tain­ing fa­cil­i­ties for six years be­fore he died of can­cer and other dis­eases at the age of 100 in 2005. As he said, he was forced to linger on be­cause peo­ple wanted him to.

An as­so­ci­a­tion was re­cently founded in Bei­jing, the first of its kind in China, to pro­mote the con­cept that it is nec­es­sary for each adult to sign a liv­ing will in ad­vance about their wishes re­gard­ing life­pro­long­ing treat­ment, in the event of ei­ther ter­mi­nal ill­ness or be­ing in a per­ma­nent veg­e­ta­tive state that dis­ables them from speak­ing for them­selves.

The liv­ing-will cam­paign can go be­yond the ex­press pur­pose of ad­vo­cat­ing a pa­tient’s au­ton­omy. The life­pro­long­ing ther­apy that keeps the ter­mi­nally ill alive on the brink of death of­ten re­sults in a painful and emo­tion­ally wrench­ing ex­pe­ri­ence, and it can eat up a fam­ily’s sav­ings.

Some pa­tients pre­ma­turely end their lives to save them­selves from suf­fer­ing and their loved ones from back­break­ing med­i­cal bills. A 67-year-old woman in Wuhan who had ter­mi­nal colon can­cer drowned her­self ear­lier this year with the help of her hus­band, who said she wanted to put an end to her pain. The old man was re­cently given a four-year sen­tence.

It may sound ruth­less to talk about sav­ing med­i­cal re­sources by with­hold­ing or with­draw­ing life sup­port for the ter­mi­nally ill, but the ra­tio­nal use of avail­able re­sources could give more peo­ple the chance of life.

Be­sides, ter­mi­na­tion of life sup­port in the last days does not nec­es­sar­ily point to med­i­cal in­ac­tion. End-of-life ser­vices, such as hospice care, are aimed at al­le­vi­at­ing suf­fer­ing and max­i­miz­ing the qual­ity of life for dy­ing pa­tients and it tends to cost less than con­ven­tional treat­ment, as some stud­ies show.

Death as a nat­u­ral process, an­tic­i­pated un­der less ex­pen­sive hospice and pal­lia­tive care rather than ag­gres­sive med­i­cal in­ter­ven­tion, can serve as a vi­able so­lu­tion. It em­bod­ies pa­tients’ au­ton­omy and helps op­ti­mize the use of med­i­cal re­sources, which holds sig­nif­i­cant mean­ing at a time when the rapidly ag­ing so­ci­ety is putting un­re­lent­ing pres­sure on the coun­try’s med­i­cal sys­tem.

It will re­quire the de­ter­mi­na­tion and ef­fort to com­pare the ex­am­ples of other coun­tries and re­gions and then en­act a nat­u­ral death act and le­gal­ize liv­ing wills that con­form to the na­tion’s con­di­tions, but the pit­falls of a rapidly ag­ing pop­u­la­tion sim­ply leave no lee­way for the coun­try to side­step the is­sue any longer.

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