At the end, to be or not to be

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 life-prolonging 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 life-prolonging 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.

The author is a writer with China Daily. gaozhuyuan@chinadaily.com.cn

(China Daily 08/15/2013 page8)

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