Shenzhen in China becomes first mainland city to make ‘living wills’ into law covering end-of-life care
- Living wills, as well as end-of-life care, are only just beginning in China because of a lack of public awareness and investment
- Most mainland people still have no idea they have an alternative to waiting for death or dying in pain when they’re too ill to speak for themselves
“It’s better to live a wretched existence than to experience a good death,” a Chinese proverb goes.
But residents in Shenzhen are for the first time being protected by the law if they want to choose the other way round when approaching the end of their life.
The southern metropolis has taken the lead in making living wills, a much debated issue in China, into law, making it the first city on the mainland to legislate for an individual’s wishes to stop treatment and die with dignity.
Under the law, medical workers should comply with living wills or advance directives made by individuals on whether or not they’ll go through emergency medical treatment or use life support when they’re reaching the end of their life. The recently passed amendment to the city’s medical regulations will take effect from 2023.
While they’re already commonly practised in the West, living wills as well as end-of-life care, which exist side by side to ensure dignity when dying, are only starting in China because of a lack of public awareness and investment.
“Shenzhen’s legislation is a big step forward, as it protects patients’ wills and also saves medical staff who provide palliative care from potential disputes,” said Tracy Wang, secretary general of the Beijing Living Will Promotion Association.
‘His own world’: modern-day hermit found living alone and reading in a cave
Widely hailed as a bold move, the new regulation comes at a time when most mainland people still have no idea they have an alternative option to waiting for death at home or dying in pain associated with treatments when they’re too ill to speak for themselves.
“At the current stage, our biggest mission is still letting more people know that there’s a third choice,” said Wang.
Mainland China ranked 53rd among 81 jurisdictions in terms of quality of death and dying, according to a global comparison released in December 2021.
Led by the United Kingdom, the top 10 best-performing jurisdictions included Taiwan, South Korea, and Hong Kong, the study, funded by the Lien Foundation, indicated.
This is already an improvement for the mainland; in the 2015 comparison study, it ranked 71st among 80 jurisdictions.
The assessment was based on performance in 13 areas including the quality of palliative care and whether patients die in a place they choose.
The promotion of living wills and palliative care has been difficult for advocates on the mainland as death is often a taboo topic in Chinese society, said Wang.
While those with religious beliefs may learn about life and death at a young age, it’s an issue much less thought of or talked about among many Chinese people, who are mostly non-religious.
“Throughout our life, from the basic education we received as children, there’s little information about life and death,” Wang said.
Twins mystery: why are so many sets of twins born in this remote Chinese village?
“We take care of babies being born. We take care of how children should be educated. But we don’t give much thought to the way we die,” she added.
Lily Liang, a white-collar woman in eastern China’s Zhejiang province whose father died of cancer a few years ago, said it was not until the recent news from Shenzhen that she learned about advance directives and palliative care.
Like most of today’s adults who grew up as children in urban China, she asked the doctors to try their best to save her father even though he was in the final stage of cancer.
“I thought giving him adequate medical treatment is part of the filial piety we’re required by society for our parents,” Liang said.
According to the National Health Commission, by the end of 2020, there were 510 hospitals across the country that provided hospice and palliative care, which is a tiny number considering China’s size.
02:01
Tens of millions under lockdown in China following outbreak of Covid BA.5 subvariant
Around 50,000 people have left their living wills with Wang’s association, the mainland’s first organisation to provide living wills online, since its inception in 2013.
As one of the fastest greying societies in the world, China had nearly 20 per cent of its population at or above the age of 60 by the end of last year. This ratio is projected to reach 28 per cent by 2040, due to longer life expectancy and declining fertility rates.
Wang believes more mainlanders will request living wills and end-of-life care as these options become better known and the proportion of older people in the population quickly expands.
“With Shenzhen making a good start, I believe ultimately similar regulations will spread across the entire country,” she said, “but this may take a very long time. After all, China is vast and medical resources are so unevenly distributed.”
