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

Singapore's founding 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 end-of-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.