Living will registration stirs dignified death debate

BEIJING - A newly-established association advocating living will registration has triggered debate on death with dignity, with many hoping the organization can help preserve patients' rights in terms of receiving life-prolonging treatments.

"The Beijing Living Will Promotion Association," which was approved by the Beijing Civil Affairs Bureau in June, gathered more than 20 medical experts on Wednesday to discuss the necessity of living wills and how to promote the idea of death with dignity in China.

A living will is a document that a person uses to make known his or her wishes regarding life-prolonging medical treatments in the event that they are no longer able to make decisions due to illness or incapacity. It is a practice deemed to show respect to patients, minimize their pain and reduce family members' financial burdens from life-prolonging treatment.

As of Thursday, more than 9,000 people have registered at the living will registration center on the association's website.

The registrants have to answer questions such as whether he or she would accept cardiac resuscitation or organ intubation before finishing the registration.

"Applicants can alter their wills at any time," said Hao Xinping, the secretary general of the association, adding that dying with dignity is still a kind of right to life.

However, there are no clinical regulations to define when doctors should stop carrying out treatment after patients enter an unconscious state, even if they have agreed to give up treatment previously in a living will.

In addition, laws or regulations have never been created to protect patients' living wills in China, an oversight which experts believe is a potential breeding ground for doctor-patient disputes.

According to a survey published by the China Hospital Management Association last year, medical-treatment disputes have seen an average 23-percent rise year on year since 2002.

Experts also agreed that it's necessary to popularize living will registration and legalize its implementation, as it can not only respect patients' wishes and bring dignity to their passing, but also help reduce doctor-patient mistrust.

"We should raise thoughts and requirements in terms of dealing with the things when we are in a coma," according to Ling Feng, an expert from the Xuanwu Hospital of the Capital Medical University.

Wang Zhong, vice director of Tsinghua University Hospital, said at the gathering that promoting living wills is a product of social development, representing progress in society, and could help people understand death from a more scientific perspective instead of being fearful of it.

But many also expressed concerns that living wills could lead to doctors' inactive treatment for patients with the excuse of the will.

"To continue carrying out treatment or not should depend on medical judgement," said Ling, stressing that doctors should not stop treating with the excuse of a patient's living will.

"Specific medical standards, relevant laws and people's acceptance are needed to promote living will registration," added Gu Jin, an expert of the Chinese Medical Association Professional Committee of Tumors.

Hao Xinping explained that death with dignity is different from euthanasia as it is natural death and follows patients' wishes in living wills, which also shows respects to patients' choices toward death.

Euthanasia, meanwhile, refers to the practice of intentionally ending a life in order to relieve pain and suffering, according to Hao.