Today, the topic of “Shenzhen Legislation Respects Patients’ Right to Decide on the End of Life” sparked a lot of discussion on Weibo.
According to reports, the “Medical Regulations (Amendment)” has carried out institutional innovation on respecting patients’ autonomy in medical care, and is the first country in the country to legislate to require medical institutions to respect patients’ wishes during their lifetime: it is clearly stipulated that medical institutions should respect The requirements of the patient’s living will, after receiving a living will that meets the prescribed conditions from the patient or his close relatives, when the patient’s incurable injury or illness is in the terminal stage or dying, the medical institution shall respect the intention of the patient’s living will when implementing medical treatment measures. .
This is the first time in mainland China that “living wills” have been incorporated into the legal system.
In January last year, the National Health and Medical Commission also stated in its reply to the “Proposal on Promoting the Development of Palliative Care”, “Through the ‘living will’ and other methods At present, the legislative conditions for implementing palliative care are not yet mature. Next, we will further study the necessity and feasibility of implementing a “living will” and establishing a “living will registration center”.”
What is a “Living Will”? How will this legislation change the medical care we receive?
Lilac Garden interviewed front-line doctors, relevant scholars, and lawyers. Here are their answers.
Living will refers to an advance instruction of the medical treatment that the patient wants to take when he loses the ability to express when he is conscious and has the ability to decide and express. Living wills are an important part of advanced directives (ADs) and advance care planning (ACP) in many countries and regions.
The promotion of living wills in my country started in 2006. Luo Diandian founded the “Choice and Dignity” public welfare website, and published the text of living wills “My Five Wishes” for the first time. On the basis of operating the website, the Beijing Living Will Promotion Association was established in 2013.
According to statistics, 30 countries and regions around the world have allowed the legal use of living wills and a series of documents with similar functions in the process of medical care.
In 2021, with the support of the Beijing Living Will Promotion Association, the Shenzhen Living Will Promotion Association was established, with Li Ying, a geriatrician from Shenzhen Second People’s Hospital serving as the president. The Shenzhen Health and Health Commission served as the business supervisory unit, and proposed to the association that the living will should be promoted in the direction of legislation.
A living will may provide some relief from family members’ moral guilt.
Affected by traditional cultural taboos about death, family members often choose to hide their illness from patients at the end of their lives; and patients who know their illness seldom take the initiative to discuss death topics with medical staff or their family members . When the end of life comes, the patient may no longer have the ability to express his or her wishes, and the decision can only be made by the family.
Jiang Yue (pseudonym), a physician in respiratory and critical care medicine at Xiangya Hospital Affiliated to Central South University, said that although many family members would sign a refusal to do invasive blood pressure, central venous catheterization, etc. Invasive operations such as CRRT and tracheal intubation are used, but when the actual need for rescue is reached, the patient’s family members will start to sway again.
Jiang Yue said that in the case of patients with little hope of doing invasive rescue, she would clearly explain to patients and their families the benefits of doing invasive rescue and not doing invasive rescue in simple language. The benefits and possible risks and complications are left to the patient and family to make the decision.
However, the decision to terminate treatment is a huge psychological stress for the family. Zhang Di, an associate professor at the School of Humanities of the Chinese Academy of Medical Sciences and Peking Union Medical College, said that during the follow-up process after the death of a patient, many family members would feel guilty, “They would ask if I didn’t rescue it at the time, or if I asked for help at that time. Extubation, did I kill my parents?”, “If there is a living will, family members and medical staff can understand the patient’s true wishes. To a certain extent, their moral responsibilities are reduced or exempted, changing the To respect the patient’s self-determination.”
As a pilot city, Shenzhen faces many challenges at the practical level in addition to laws and regulations.
On the one hand, as a professional medical legal document, the premise of the true representation of the patient’s intention is to understand the medical concept in it.
“For example, what is life-sustaining intervention? What level of rescue should be done? Cardiac compression or endotracheal intubation?” Zhang Di said, when signing a living will, a professional should provide it guidance to make sure they understand what a living will means.
In a clinical setting, having a living will also should not mean that the decision of treatment is entirely up to the patient.
Lawyer Mao Yunfeng said that it is necessary to have detailed rules to further clarify the scope: which traumatic rescue measures can be decided not to be implemented by dying patients by a living will; in addition, there must be a correspondingly qualified doctor to evaluate Patients are indeed in the terminal stage of an incurable disease, and the damage from invasive rescue measures far outweighs the benefits. “It is not recommended to implement this provision immediately before the corresponding implementation rules are issued. It cannot be ruled out that some people will maliciously use this provision and cause moral and legal risks.”
The wishes of the family members are equally important. Chinese people value family culture and believe that the ideal hospice should be peaceful for the deceased, peace for the living, and a safe and smooth environment. Therefore, they only pay attention to the appeals of the deceased and do not care about the family members. Such differences are still thorny.
What do you think about end-of-life decisions?
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Part of the content source: Lilac Garden | Planning: jiu | Producers: Feidi, Eric