"I really want to die..." Lao Liu is a terminal cancer patient. This is what he repeated repeatedly when he was lying awake in the hospital bed. He was lying on the ICU bed, surrounded by cold machines. He could only breathe through an oxygen mask. A hole was opened in his throat

"I want to die so much..."

Lao Liu is a terminal cancer patient. This is what he repeated repeatedly when he was lying awake in the hospital bed. He was lying on the hospital bed ICU, surrounded by cold machines. , he could only breathe through an oxygen mask, a hole was opened in his throat, and a tube was connected to the ventilator. He could only eat through nasal feeding .

He has been in a coma for three days. No one paid attention to Liu's wishes when he woke up. The doctors were helpless and the children couldn't bear to leave their father. In China, too many children think that letting the old man live one more day is filial piety, otherwise it is unfilial. They struggled to use the most advanced medical equipment to keep their father alive, even if all that was left was a body without a soul.

01 Professor Liu Duanqi of the People's Liberation Army General Hospital has been actively promoting living instructions , that is, patients should leave instructions in the last stage of life and the terminal stage of incurable injuries, not to perform excessive rescue, and not to perform any treatment that causes pain. Invasive treatment, but to allow death to come in the most dignified way.

As an oncologist, Professor Liu Duanqi often says to some patients with advanced cancer : "Buy a boat ticket and travel around the world." What he gets in return is incomprehension and complaints from their family members. Without a living will, he saw too many patients who died of excessive pain in the ICU due to the insistence of their families or the doctors' outdated ideas.

Recently, good news has come from the legal community. Living wills have been legalized for the first time in Shenzhen. End-of-life resuscitation is no longer decided by family members, but by patients leaving instructions when they are conscious to decide whether to continue treatment.

1. Return the right to choose death to the patient. What is a living will?

htmlOn June 23, the " Shenzhen Special Economic Zone Medical Regulations " made bold, innovative and humane changes. Article 78 of the revised draft stipulates: After receiving qualified pre-mortem medical information from patients or their close relatives, According to the instructions, medical institutions shall respect the patient's prior wishes when they implement medical measures at the end of the patient's incurable injury or death or when he or she is dying. This means that the patient has the "right to make decisions" before dying, and if there is a will in front of him, he does not need to perform "useless resuscitation".

It is understood that this living will is signed by people in advance, that is, when they are conscious, and can explain what kind of medical care they choose to receive in the terminal or dying stage of incurable injuries.

Some people misread "living will" as "giving up treatment". In fact, a living will does not mean passively giving up treatment, nor is it euthanasia. Doctors will not give up on the patient because he signed a living will when the patient still has hope of life. Under the premise, give up active treatment methods at will.

Li Ying, a geriatrician at Shenzhen Second People's Hospital explained that only if the patient's symptoms cannot be reversed after medical treatment, the advance instructions will be carried out. If life support measures are helpful in alleviating symptoms, the patient can continue all life-saving measures.

Li Ying said that life and death are very complex issues, and living directives can be changed at any time according to the patient's wishes. On the premise of respecting the patient's choice, let the patient accept death calmly.

2. Reflection: The first hospital to implement "living wills" has been put on hold

A survey in Hangzhou showed that 4.9% of people are willing to use living wills, and 77.8% support the promotion of living wills , but the reality is cruel. Many places have not promoted living wills. In 2019, Jiangsu Geriatric Hospital was the first to trial the "living wills", but now it is basically on hold.

Why is it difficult to implement a living will?

. Imperfect laws

In most areas of our country, living wills are a kind of private initiative. Before the revision of the "Shenzhen Special Economic Zone Medical Regulations", there was no other legal support and protection, and there were certain legal risks.

. Strong traditional concept of children

Patient’s family members are a big problem for living will. Although the old man is dying, if his children do not "try their best to save him", they will inevitably leave behind regrets and blame themselves for not being "filial". Externally, they are worried about leaving evidence and being said to be "unfilial" and "not willing to spend money." money".

. It may be used maliciously

Taking into account the large medical expenses and the possible behavior of defrauding commercial health insurance, living wills may be maliciously used by malicious people, which also makes the earliest trials of "living wills" difficult. .

3. Only when you know how painful is the terminal stage of cancer, can you understand the importance of giving up at the right time.

At what point would a patient choose "death" rather than linger on? That must be facing something more terrifying than "death", and the pain that terminal cancer patients have to face is precisely so "too painful to live."

. The ever-present cancer pain is like eating shards of glass

The 2014 National Cancer Center registration records show that the incidence of pain in patients with advanced cancer is about 0%~80%, and 40% of the patients suffer from severe pain. Some patients described the pain as feeling like eating shards of glass, from the throat to every part of the body being cut. The pain came over and over again and never stopped for a moment.

. Cannot eat or drink, nor can they be excreted normally

The nutritional status of in the late stage of cancer is also very worrying. In the late stage, it is very common for patients to suffer from pain and lose their appetite and be unable to eat. If nutrition cannot keep up, immunity will also decline, allowing tumors to gain the upper hand. For intestinal obstruction and urinary system blockage caused by tumors, patients may be unable to discharge "waste" from the body smoothly, causing bacteria to ferment in the body, which can lead to serious infections.

. Being unable to sleep at night and being unable to sleep normally

Insomnia is one of the common symptoms of cancer patients. Due to pain, patients cannot have high-quality sleep, and if they do not sleep enough, they will be in a state of anxiety and depression, and the mental pressure will be heavier, aggravating the condition. , causing a vicious cycle.

. Infection, massive bleeding, and various complications

In the terminal stage of cancer, patients have low immunity. In addition, after a series of treatments, the immunity is destroyed, the number of white blood cells drops seriously, and they are very susceptible to infection. This is why cancer patients die more often. One of the causes of complications. In addition, as the tumor continues to grow and invade blood vessels, the patient's tumor ruptures, causing massive bleeding. The bleeding process is often dangerous and abnormal, and can cause death in a short period of time.

The reason why Xiao Ai wrote this article is not to tell everyone that late-stage cancer is very painful, and if you can’t bear it, you have to give up treatment. Some late-stage cancers still have a chance of long-term survival, but when it is incurable, you must put people first. Don't fall into excessive medical treatment, respect the patient's wishes before death, give the patient the final dignity, and achieve peace of mind between life and death. #HealthTruthPlan#

Reference:

[1] "The first in China!" Shenzhen legislation: If a patient makes a living directive "not to perform unnecessary resuscitation," the hospital must respect his wishes. Beiqing.com.2022-07-04

[2] "Living Directive Entered into Law for the First Time: It is up to the patient to decide on end-of-life resuscitation" ".Beiqing.com.2022-07-04

[3] 2022,42(02):153-157.

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