On March 21, 2021, Beijing Songtang Care Hospital, an old man was walking in the passage outside the ward. At the end of the passage is Daisy House, a ward specially designed for children's hospice care. Photographed by Beijing News reporter Wang Jianing
According to reports, the 10th meeting of the Standing Committee of the Seventh Shenzhen People's Congress recently voted to adopt the revised " Shenzhen Special Economic Zone Medical Regulations ". Among them, Article 78 makes a bold breakthrough in the "right to make end-of-life decisions", stipulating that if a patient makes an advance directive "not to perform unnecessary resuscitation", the hospital must respect his wishes and allow the patient to spend his last days peacefully. Shenzhen has therefore become the first region in the country to implement living will legislation.
This new regulation is a great blessing for terminal patients who cannot bear the pain of excessive rescue. When a person is about to die, it is difficult to express personal wishes and even more difficult to be respected. Especially when various catheters are inserted into the patient's body, the patient's opportunity to speak and communicate is lost, and it is almost impossible to express his thoughts. Even if the patient is in great pain due to excessive rescue, he can only passively endure it until the end of his life.
However, with living directives are different. Patients can make independent arrangements in advance whether to adopt traumatic rescue measures such as intubation and cardiopulmonary resuscitation for end-of-life rescue, and whether to use a life support system. Moreover, this kind of living will is legally binding and there is no need to worry about doctors and family members changing it at will. A problem that has long troubled the families of dying patients is also expected to be resolved.
Especially for the children and other relatives of elderly patients, even though the patient is dying, if they do not "try their best to rescue", they are afraid of leaving regrets for themselves and blaming themselves "I harmed the elderly" in the future; I am afraid of being accused of being unfilial and being reluctant to spend money. If the elderly have multiple children, the child who advocates "giving up rescue" may also be criticized by other children.
Under the pressure of these traditional concepts and public opinion, it has become a common phenomenon to "never give up until the end" even though it is impossible for any medical treatment to reverse the disease. Excessive medication, examinations, and even excessive rescue during this process not only increase the financial burden on the patient, but also cause pain to the patient and cause a certain degree of waste of medical resources.
With a living will, the relevant decisions come from the patient himself and are supported by the law, so family members no longer face this dilemma. At the same time, it also gave doctors reassurance.
Prior to this, the private sector was also vigorously promoting living wills. For example, Beijing Living Wills Promotion Association was well known in the industry. Its related website launched "My Five Wishes", which has been filled out by more than 50,000 people in China.
However, this kind of private advocacy does not have legal effect. Once relatives of patients object to this, medical institutions and doctors may face civil infringement claims or administrative penalties from the competent authorities. This huge risk of uncertainty makes doctors afraid to make decisions. Therefore, when a patient is in critical condition, it is not uncommon for the hospital to still uphold the medical spirit of saving lives and rescuing the patient needlessly.
After legislation is passed and living wills become legally binding, doctors will no longer have to worry about making choices within the legal framework.
And this process is also a process of promoting the transformation of traditional concepts from the institutional level. Sometimes, rescuing at all costs is not what patients want to see, nor is it the best way to protect the dignity of life. It should not be used to judge the choices of patients' children, hospitals, and doctors from the moral high ground.
In this regard, Shenzhen took the lead in establishing a "living will system" in the country, and its value in conceptual guidance and institutional exploration of "end-of-life decision-making rights" should not be underestimated.
establishes a living will system and gives patients the right to decide on end-of-life rescue through legislation, bringing peace to the elderly suffering from diseases with no hope of medical rescue and treatment, and changing their deaths from "regret between life and death" to "peace between life and death."
should also realize that there is still a long way to go before the perfection and popularization of living wills in our country. Living wills involve many legal and medical professional concepts, which are difficult for patients to understand. Before signing a living will, patients must be provided with professional guidance and services.Including whether traumatic rescue is worth implementing, how to evaluate the damage and benefits, etc., the operating specifications must also be improved to make them followable.
In addition, when living wills are enacted into law, malicious use must be avoided. For example, end-of-life rescue medical expenses are very high, and health commercial insurance must be careful not to exaggerate the role of living wills.
Although living wills have been enacted into law for the first time and the rules may not be mature yet, Shenzhen’s institutional exploration in this area will inevitably accumulate experience and create a scientific model for the popularization of living wills in my country, ultimately giving every patient the right to choose With your own end-of-life rescue methods, you can die calmly and with dignity. Written by
/ Edited by Luo Zhihua (doctor)
/ Proofread by Chi Daohua
/ Lu Qian
