Chinese concepts of euthanasia and health care

Bioethics

Volumn 20, Issue 4, 2006, Pages 203-212

  Sleeboom Faulkner, Margaret ^a  

^a LEIDEN UNIVERSITY   (Netherlands)

Author keywords

Biomedical textbooks; China; Decriminalization; Euthanasia; Healthcare system; Legislation; The Netherlands

Indexed keywords

CHINA; CONCEPT ANALYSIS; DEATH; EUTHANASIA; HEALTH CARE; HEALTH CARE POLICY; HEALTH CENTER; HUMAN; LAW; POLITICS; PUBLICATION; QUALITY OF LIFE; REVIEW; TERMINAL DISEASE; WELFARE;

DEATH AND EUTHANASIA;

ATTITUDE OF HEALTH PERSONNEL; CHINA; CRIMINAL LAW; CROSS-CULTURAL COMPARISON; DELIVERY OF HEALTH CARE; EDUCATION, MEDICAL; EUTHANASIA, ACTIVE, VOLUNTARY; HUMANS; NETHERLANDS; PUBLIC OPINION; PUBLIC POLICY; RESOURCE ALLOCATION; SUICIDE, ASSISTED;

EID: 33745840835     PISSN: 02699702     EISSN: 14678519     Source Type: Journal    
DOI: 10.1111/j.1467-8519.2006.00495.x     Document Type: Review

References (60)

1. I am greatly indebted to Matthijs van den Bos for his critical reading and advice, and I am very grateful to the reviewers of this article for their helpful and constructive comments and suggestions.
2. Felici vel honesta mort mori. Dietrich von Engelhard. 1994. The Ethics of Paediatrics and the Ill Child in History. In Primum Non Nocere Today. A Symposium on Pediatric Bioethics. Burgio, G. Roberto & John D. Lanton, eds. International Congress Series 1071, Amsterdam: Elsevier: 13-23.
3. Nie Jing-Bao. 2004. Medical Ethics through the Life Cycle in China. In A History of Medical Ethics. Robert Baker & Larry McCullough eds. Cambridge, Cambridge University Press: Chapter 6.
4. Liu Weiming. 2001. Support for Euthanasia Grows among Chinese People. China News Digest International (CND) 05/11/01. Available at: http://www.cnd.org/Global/02/11/29/021129-94.html [Accessed 9 May 2006].
5. P.J. van der Maas has conducted an official study of the practice of euthanasia and other medical decisions relating to the end of life in the Netherlands. This study was conducted in 1991 based on a sample of deaths in 1990 and details of some deaths in early 1991. It is often referred to as the Remmelink report, named after the former Procurator-General of the Supreme Court in the Netherlands, who initiated the study. The follow-up study was published in 1996 and based on a sample of deaths in 1995 and using a similar methodology. For an account in English, see P.J. van der Maas et al. Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990-1995. N Engl J Med 1996; 335: 1699-1705.
6. P.J. van der Maas et al. Euthanasia and other medical decisions concerning the end of life, Lancet North Am Ed 1991; 338: 669-674.
7. This definition was first formally used by the Dutch State Commission for Euthanasia in 1985 (Staatscommissie Euthanasie. 1985. Rapport van de Staatscommissie Euthanasie, 's Gravenhage: Staatsuitgeverij).
8. The Dutch State Commission for Euthanasia defines assisted suicide as 'deliberately assisting a person in a life-terminating act at his or her explicit request'; a life-terminating act without an explicit request is defined as 'deliberately terminating the life of a person without his or her explicit request.' (Cf. Final report of the Dutch State Commission: an English summary, Bioethics 1987; 1: 163-174;
9. H.H. Van der Kloot Meijburg. How health care institutions in the Netherlands approach physician-assisted death. Omega (Westport) 1955-96; 32(3): 170-196).
10. The use of the concept of 'passive euthanasia' is no longer customary in official legal and political documents in the Netherlands. For a more elaborate discussion of the distinction between abstaining from treatment in order to 'let die' (dood laten gaan) and (active) euthanasia, and the reasons for ignoring it, see Griffith, Bood & Weyers. 1998. Euthanasia & Law in the Netherlands. Amsterdam: Amsterdam University Press: 158-161. The authors argue that it is doubtful that the distinction has any moral relevance, especially in a medical context. For the doctor is morally accountable for everything that happens to the patient for whose care he is responsible. This includes the decision to abstain from treatment. Even the 'mere omission' of treatment cannot be an excuse for abandoning a patient to his fate. Therefore, be it killing or letting die, in both cases the physician is equally accountable.
11. Oregon and the Netherlands are the only two jurisdictions in the world where laws specifically permit euthanasia or assisted suicide. Oregon permits assisted suicide. The Netherlands permits both euthanasia and assisted suicide. In 1995 Australia's Northern Territory approved a euthanasia bill. It went into effect in 1996 but was overturned by the Australian Parliament in 1997. Also, in 1997, Colombia's Supreme Court ruled that penalties for mercy killing should be removed. However the ruling does not go into effect until guidelines, still to be drafted, are approved by the Colombian Congress (See documents by Rita L. Marker and Kathi Hamlon. Euthanasia and Assisted Suicide: Frequently Asked Questions. International Task Force on Euthanasia and Assisted Suicide, Box 760 - Steubenville, Ohio 43952).
12. For details, see the web site of the Dutch Ministry of Foreign Affairs on euthanasia http://www.minbuza.nl/defAULt.Asp?CMS_ITEM=MBZ461025 [Accessed 9 May 2006].
13. A written declaration of will has the same status as a concrete request for euthanasia.
14. It is necessary to note here that this system of regulation is problematic. The problematic cases are not reported, that is, none of the cases of life termination were without an explicit request.
15. Fewer than five cases per year are prosecuted (Griffith, Bood & Weyers 1998, Euthanasia and Assisted Suicide: Frequently Asked Questions op. cit. 8: 268).
16. In fact, this includes the Netherlands, as it is not absolutely clear that in budgetary calculations the practice of euthanasia is not included. On the other hand, the many administrative requirements, such as the consultation of other specialists, the writing of reports and the risk of indictment do not seem to make for an lucrative item for economising.
17. Critical discussions on the various positive and negative aspects of euthanasia, after the Netherlands became the world's first country to decriminalise it, have been held in academic journals, such as Yixue yu Zhexue (Medicine and Philosophy), Zhongwai Yixue Zhexue (Medical Philosophy in China and Abroad), and Zhongguo Yixue Lunlixue (Chinese Medical Ethics), in the press and on television stations such as CCTV.
18. Du Jinxiang & Wang Xiaoyan. 2002. Yixue Lunlixue Jiaocheng (A Course in Medical Ethics). Beijing: Kexue Chubanshe;
19. Liu Xueli. 2001. Shengming Kexue de Lunli Kunhuo (The Ethical Predicament of BioScience). Shanghai: Shanghai Kexue Jishu Chubanshe;
20. Shi Weixing, He Lun & He Gang. 2002. Shengwu Yixue Lunlixue (Biomedical Ethics). Hangzhou: Zhejiang Jiaoyu Chubanshe;
21. Lu Lina & Zhu Zong. eds.. 1999. Lishi yu Xianzhuang. Gaoxin Keji zai Yixue lingyu de ying yong (The Application of Advanced Science and Technology in the Medical Field). Beijing: Changcheng Chubanshe;
22. Zhu Shen & Zhang Xiuyun, main eds. 2000. Yixue Lunlixue (Medical Ethics). Changsha: Guofang Keji Daxue Chubanshe;
23. Du Huiqun, Tu Ya & Liu Ji. 2001. Kexuie Jishu (Yizue) yu Shehui Jiaocheng (A Course on Science and (Medical) Technology and Society). Beijing: Junshi Yixue Kexue Chubanshe;
24. Lu Qihua, main ed. 1999. Yixue Lunlixue (Medical Ethics). Beijing: Huazhong Keji Daxue Chubanshe;
25. Wang Chengju Zhang Duolai, main eds. 2000. Yixue Lunlixue (Medical Ethics). Changsha: Guofang Kexji Daxue Chubanshe;
26. Qiu Xiangxing, main ed. 1999. Yixue Lunlixue (Medical Ethics). Beijing: Renmin Weisheng Chubanshe;
27. Li Benfu, Li Chuanjun & Cong Yali, main eds. 1999. Yixue Lunlixue (Medical Ethics). Beijing: Beijing Yike Daxue Chubanshe.
28. Some textbooks contain near-identical passages, using similar wordings, distinctions and arguments, without any mentioning of their source, and none of the textbooks quoted give credentials to their authors.
29. The Cultural Revolution (1966-76) denotes a period of social upheaval that started as a struggle between Mao Zedong and other top Party leaders for the leadership of the Chinese Communist Party, but continued to spread all over China as a movement of 'struggle' and call for 'continual revolution.'
30. Du Jinxiang & Wang Xiaoyan, 2002, Yixue Lunlixue (Medical Ethics) op. cit 15: 196.
31. Zhou Yiman Shiwang biaozhun yu anlesi (Death criteria and euthanasia), in Lu Lina & Zhu Zong, 1999, Yixue Lunlixue (Medical Ethics) op. cit. 15: 149.
32. Shi Weixing, He Lun & He Gang, 2002, Yixue Lunlixue (Medical Ethics) op. cit. 15: 309-11.
33. Shi Weixing, He Lun & He Gang, 2002, Yixue Lunlixue (Medical Ethics) op. cit. 15: 315.
34. Zhou Yiman, 1999, Yixue Lunlixue (Medical Ethics) op. cit. 15: 149
35. Zhou Yiman, 1999, Yixue Lunlixue (Medical Ethics) op. cit. 15: 149.
36. Shi Weixing, He Lun & He Gang, 2002, Yixue Lunlixue (Medical Ethics) op. cit. 15: 315.
37. Shi Weixing, He Lun & He Gang, 2002, Yixue Lunlixue (Medical Ethics) op. cit. 15: 315-20.
38. Shi Weixing, He Lun & He Gang, 2002, Yixue Lunlixue (Medical Ethics) op. cit. 15: 317.
39. Shi Weixing, He Lun & He Gang, 2002, Yixue Lunlixue (Medical Ethics) op. cit. 15: 319.
40. Zhu Shen & Zhang Xiuyun, 2000. Yixue Lunlixue (Medical Ethics) op. cit. 15: 161-2.
41. Zhu Shen & Zhang Xiuyun, 2000, Yixue Lunlixue (Medical Ethics) op. cit. 15: 162.
42. Du Jinxiang & Wang Xiaoyan, 2002, Yixue Lunlixue (Medical Ethics) op. cit. 15: 198.
43. Du Jinxiang & Wang Xiaoyan, 2002, Yixue Lunlixue (Medical Ethics) op. cit. 15: 200.
44. Du Jinxiang & Wang Xiaoyan, 2002, Yixue Lunlixue (Medical Ethics) op. cit. 15: 194.
45. Lu Qihua, 1999, Yixue Lunlixue (Medical Ethics) op. cit. 15.
46. The Royal Dutch Medical Association (KNMG) and authorities on euthanasia in the Netherlands such as Van der Wal and Van der Maas do not take into account the financial aspects of the practice. This is so, not because Dutch society values ethics more than others do, but because its highly developed welfare facilities divert attention away from them.
47. The third annual report on deaths under the Oregon assisted suicide law illustrates this possibility. In 63% of the deaths reported, fear of being a burden was expressed as a reason for requesting assisted suicide. (Rita L. Marker & Kathi Hemlon, Euthanasia and Assisted Suicide: Frequently Asked Questions, International Task Force on Euthanasia and Assisted Suicide http://www.internationaltaskforce.org/sptlt2.htm, p. 43. [Accessed 10 December 2004].
48. Shi Weixing, He Lun & He Gang, 2002, Euthanasia and Assisted Suicide: Frequently Asked Questions op. cit. 15: 310;
49. Lu Qihua 1999; Cong Yali. The first euthanasia court case in China. Eubios J Asian Int Bioeth 6 1996: 61-62.
50. Liu Weiming, 2001, Eubios J Asian Int Bioeth op. cit. 15.
51. Lu Qihua, 1999; Cong Yali, 1996, Eubios J Asian Int Bioeth op. cit. 15: 61-62.
52. Though the majority of the Chinese people interviewed advocate euthanasia, thus far, the courts have found guilty all defendants in China's lawsuits regarding euthanasia guilty in light of Article 132. However, all defendants have been sentenced only in the lightest sense of the crime of 'killing'. Lin Yu & Dapu Shi 2002, http://cae.hkbu.edu.hk/html/CIPM/199802/ yuE.html [Accessed 16 May 2006].
53. In China the public health care programme for farmers is on the edge of bankruptcy because of skyrocketing medical costs caused by newly introduced advanced technologies in medicine and market mechanisms (Qiu Renzong. 1999. Medical Ethics in China: Status Quo and Main Issues. In Chinese Scientists and Responsibility: Ethical issues of Human Genetics in Chinese and International Contexts. Proceedings of the 'First International and Interdisciplinary Symposium on Aspects of Medical Ethics in China: Initiating the Debate'. Ole Döring (ed.) Mitteilungen des Instituts für Asienkunde Nr. 314, Hamburg: 24-32).
54. China's peasants, constituting 70% of the population, are not insured by the public health system. Only 15% of them participate in locally organised healthcare schemes. Most peasants, however, are not covered by any form of health insurance. (Zhu Fangfang, ed. 2001. 'Anquanwang' he 'Jianzhenqi' (Safety Net' and 'Shock Absorber'). Beijing: Zhongguo Guoji Guangbo Chubanshe).
55. Cong Yali, 1999, 'Anquanwang' He 'Jianzhenqi' (Safety Net' and 'Shock Absorber') op. cit. 15.
56. Cong Yali, 1999. 'Anquanwang' He 'Jianzhenqi' (Safety Net' and 'Shock Absorber') op. cit. 15.
57. Proponents of legalising euthanasia have voiced critical views on the way it has been formulated and carried out in the Netherlands. According to Griffith et al., medical behaviour that intentionally shortens life is far more widespread than is generally recognised and in many such cases the patient is not adequately consulted (Griffith, Bood & Weyers, 1998, 'Anquanwang' He 'Jianzhenqi' (Safety Net' and 'Shock Absorber') op. cit. 7: 26;
58. G. van der Wal, P.J. van der Maas; met medew. van J.M. Bosma et al. 1996. Euthanasie en andere medische beslissingen rond het levenseinde: de praktijk en de meldingsprocedure. Den Haag, Sdu: 99-101;
59. for a summary in English, see also Van der Wal & van der Maas, 1996, et al. (1996) Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990-1995. N Engl J Med 335, 1699-1705). And in the view of Keown, who encourages various forms of euthanasia, current legal control over euthanasia in the Netherlands cannot be considered effective. This he blames partly on the permeability of the boundaries of euthanasia with other forms of medical behaviour that shorten life.
60. Another reason for poor efficacy is that GPs in the Netherlands are expected to report each case, leaving it up to the GPs themselves to classify the nature of the circumstances of death, after which they sign the death-certificate (Damien Keown. 1995. Euthanasia in the Netherlands: sliding down the slippery slope? In Euthanasia Examined. Ethical, Clinical and Legal Perspectives. Keown, ed. Cambridge: Cambridge University Press).