Artificial system

No artificial survival, I want to die in peace and dignity


A southern city has become the first jurisdiction in China to enact legislation allowing a terminally ill patient to refuse “excessive vital treatment” and die with dignity and comfort.

Shenzhen’s new law in Guangdong province, which will come into effect on January 1, follows a common practice in many countries, where people with incurable diseases near the end of their lives have the right to decide their death.

According to a revised draft city medical treatment bylaw, which passed last month, patients with terminal or end-of-life illnesses can create advanced care directives, or living wills, that reject artificial life-sustaining treatments such as tube feeding. or cardiopulmonary resuscitation to prolong life.

Right-to-die legislation in other countries has sparked public debate about the ethics of ending life by choice. China is no exception. Shenzhen’s new law has sparked heated national discussions on social media.

I am in favor because it respects his own will, which is a great legal improvement. But, of course, we also need to pay attention to process design to avoid gaps in implementation that could be inappropriately exploited.

Weibo user

“Let people live in freedom and die with dignity,” posted one netizen, whose comments received around 1,100 positive responses. “For a patient who has suffered a lot, the new regulations would make him suffer less in his last days.”

“I’m in favor because it respects his own will, which is a big legal improvement,” another Weibo user wrote in a comment. “But, of course, we also need to pay attention to process design to avoid gaps in implementation that could be exploited inappropriately.”

Others have also expressed concern that living wills could be abused by medical staff or families who disagree with these guidelines. Wills must be signed by two witnesses.

At the heart of a debate is how to judge whether a patient is in the final stages of life.

“It is primarily a medical judgment issued by a medical institution,” said Lin Zhengmao, deputy director of the legal work committee of the Shenzhen Municipal People’s Congress Standing Committee. “That’s not what the patient or other people close to the patient think.”

The newly adopted regulations require a document signed while a person is still conscious and in full mental capacity. The document must specify what the patient wishes in terms of maintaining vital functions as the end of life approaches.

Shenzhen established the Living Will Promotion Association in March last year. It provides a channel for people to create living wills in the form of written documents, videos or audio recordings, and can also include guidelines for families.

The new rule could ease the mental anguish of family members and medical staff.

The Chinese tradition of cherishing life and filial obligations often leads children to accept all possible treatment for their parents, even when death is inevitable.

Medical workers, too, often find themselves in awkward positions.

“The advanced care guideline allows a doctor to act according to the wishes of the patient who does not want to be kept on life support and just wants to die in peace,” said Liang Zhen, deputy director of Shenzhen People’s Hospital. . “It protects the rights and interests of the patient and helps avoid medical disputes.”

No artificial survival, I want to die in peace and dignity


A professional assessment of a patient’s physical and mental conditions should be completed before an advanced care directive comes into effect.

“The patient’s independent determination is the most important thing,” Liang said. “We have to make sure the patient is not coerced or unduly influenced.”

It’s important to involve the family in the decision, said Wang Yue, a professor in the Department of Medical Ethics and Law at Peking University’s School of Health Humanities.

“It would be best to achieve cognitive consensus on the advanced care directive with loved ones through family meetings,” he said. “The whole process should be videotaped to avoid possible conflicts in the future. By having meetings, it respects the patient but also the family members.”

Although right-to-die guidelines are sometimes called “voluntary euthanasia” in the West, Chinese authorities have said that term is inappropriate here. Euthanasia, where terminally ill patients have the right to subjectively end their lives at a time of their choosing, is illegal in China – as it is in most countries.

Right-to-die practices have existed in China for some time, although they are not enshrined in law.

Famous Shanghai cartoonist He Youzhi, who died in 2016 at the age of 94, often joked that he “wished to be slow to age and quick to die”.

His wife Xie Huijian, recalling conversations with her husband, refused medical treatment to open her esophagus in the last days of her life.

“I said no because he always told me, when he was conscious and mentally aware, not to save him if death was unavoidable,” she said. “I wanted him to leave this world comfortably.”

A living will is the oldest form of advance care directive. It was first offered in the United States in 1967. A 2020 Gallup poll found that 45% of Americans had written living wills, up from 40% in 2005. Such directives were more common among people with higher education and higher incomes.