'Living will' regulation to debut in Shenzhen

Patients in Shenzhen, Guangdong province, will be allowed to decide, starting next year, whether they want to undergo certain lifesaving measures at the final stage of their life, according to a newly amended city regulation.

The move, reportedly the first in the Chinese mainland, has received wide public attention, as it touches on one of the core concerns of elderly people－whether they can decide how they die.

Under the revised regulation adopted late last month by the Standing Committee of the Shenzhen People's Congress－the local legislature－if a patient makes a "living will" that clearly states he or she does not want to receive treatment, such as intubation or cardiopulmonary resuscitation, or be placed on life support, medical workers should respect that decision.

The regulation, which will take effect on Jan 1, is seen as a pilot practice for the rest of the country, as it reportedly makes Shenzhen the first place nationwide to formally recognize the living will through legislation.

It stipulates that a Shenzhen resident can sign a living will in advance, while conscious and aware, specifying what kind of medical care he or she wants at the end of an incurable illness or in the final stages of life. Healthcare providers will be required to abide by the terms outlined in the will.

"Writing the living will into a legal document is necessary, because in this way patients' right to make an end-of-life decision will be better protected," said Li Ying, head of the Shenzhen Living Will Promotion Association.

"A living will, along with hospice care, can help people die peacefully and with dignity. It will be a comfort for patients and their families," said Li, who is also a physician specializing in healthcare for the elderly.

The regulation quickly triggered widespread public attention after being reported by local media, with many people voicing support for living wills.

As of Wednesday, more than 30 topics on Sina Weibo, China's Twitter-like platform, were related to the regulation, and one topic-"legislation on living will for the first time"－had received around 25 million views.

A Sina Weibo user commented that a living will is not only a good way to protect patients' dignity and right to make end-of-life decisions, but also solves a predicament that has long affected dying people and their family members.

Xu Hao, a lawyer from Beijing Jingsh Law Firm, said he regarded the local legislation on living wills as a breakthrough, adding that it could be viewed as implementing stipulations in the country's Civil Code regarding people's right to life and dignity.

Recalling his grandfather's experience with cancer, Xu said the elderly man was intubated in the intensive care unit and was conscious and in pain at the end of his life.

"We knew that resuscitation in view of his incurable disease was meaningless, but we finally agreed to let doctors take lifesaving measures for him," Xu said.

"The resuscitation was actually a comfort for us, but not for my grandpa. He might have been uncomfortable," he said. "If I had another chance, I would first ask my grandpa if he needed the treatment and respect his decision."

Xu expressed some concerns about verification of the wills. "For example, determining whether the patient's wish is genuine or coerced, I think, needs a committee or a professional institute to evaluate," he said. "Respecting patients means we must ensure that their decisions are made by themselves and they have the ability to do that."

In addition, patients should have the right to change their mind, as many will have a strong desire to survive when they are facing death, he added.

On Tuesday, Lin Zhengmao, deputy head of the legal affairs commission of the Shenzhen legislature, said that healthcare providers should respect patients' decisions if they want to withdraw living wills.

He also emphasized that what constitutes the final stage of life needs to be determined by a medical institution rather than by patients or other individuals.