The Asian way on death
The Oriental view on euthanasia reflects the Oriental view on life and death. Oriental view on life stress on the importance of following the natural way, and seeing life and death as a continuous process. It is also, from the humanitarian and merciful point of view, seen that one should die decently and with dignity in the natural way - rather than struggling with pain during the last minutes, hours or even days when one should have died naturally. In the East, death is part of life, and so death is not something to fear or avoid.
On March 1994, a group of National Peoples Congress (NPC) delegates proposed a law in support to euthanasia and which they claimed would promote socialist humanism 1 - claiming euthanasia under prescribed conditions was feasible in China. One of the delegates, Dr. Hu Ya-mei made the point, "Some old people have lost the ability to look after themselves and their minds are no longer clear."2 According to the China National Committee on Aging, the population of elderly over 65 in China is 6.5 percent, will be 10 percent by 2000, and 25 percent by 2050 3.
Later in 1994, at an academics meeting in the Shanghai Medical University, China's medical experts agreed China should adopt euthanasia provisions and should draft legislation to regulate the practice 4. Surveys conducted in Beijing, Shanghai, Hebei and Guangdong showed a growing number of Chinese favoring a euthanasia policy. Seventy-three percent of 200 elderly people interviewed in a survey in Shanghai, and 79.8 percent of 500 interviewees in Beijing, supported euthanasia.
In March 1995 more than 30 delegates from Beijing and southern Hunan and Fujian provinces again urged the NPC to legalize euthanasia 5, in the wake of the imprisonment of a man who assisted his cancer-stricken wife to commit suicide. The 54-year-old Hunan resident Liu Shabo, was convicted of murdering Wu Xiuyun after complying with his wife's wishes when he gave her a cup of tea laced with deadly pesticide. Although euthanasia, which has been used in rare cases since the early 1980s, raises sharp moral issues, "pro-euthanasia" delegates claim the idea must be faced as the aging population increases and market reforms cause medical cost to soar. In 1994, a major Beijing hospital volunteered to pioneer the practice when conditions are ripe. A survey conducted by the No. 2 Military Medical University's Shanghai Hospital showed that 93.6 percent of 313 people interviewed approved of euthanasia 6.
Again in March 1996, Wu Zhaoguang, a professor at Shanghai's Zhongshan Hospital and also a NPC delegate, argued that a euthanasia law should be introduced in China as soon as possible to relieve patients from suffering incurable diseases 7. Wu also proposes that euthanasia first be tried in Beijing and Shanghai, where medical conditions are relatively advanced.
Despite delegates' repeated requests for legalizing euthanasia, it remains illegal in China. But a hospital in Kunming province recently admitted that it had provided assistance to hastening death on over twenty occasions 8. Physician assisted suicide is not legal in China, but it is covertly acceptable.
In January 1996 9, a 74-year-old Taiwanese woman, who was known to have stomach cancer, pleaded to Taiwanese authorities to grant euthanasia for her daughter. The daughter, a former high school bandleader, had been in a coma condition after a traffic accident 32 years previously. The elderly lady, Wang Chao Hsi-nian, said she would also write to President Lee Teng-hui asking for sympathy for family members of peersons in a vegetative state. But euthanasia remains illegal in Taiwan.
Although the Hong Kong Government, in June 1996, dropped plans for guidelines on euthanasia 10 - claiming that there was little public interest in the issue - but the debate did not stop. One writer 11argues that Australia's Northern Territory euthanasia law 12 should be extended to Hong Kong, as advances in medical science and medical research are artificially extending the life of dying patients, and in most wretched conditions.
Earlier in June 1995, in response to legislators urging the legalization of euthanasia in Hong Kong, the Secretary of Health and Welfare, Katherine Fok Lo Shiu-ching, replied that, "As this (euthanasia) is an issue with moral, ethical, social and legal implications, there is need to seek views not only within the medical profession, but also from the community.'13
As early as 1993, the Hong Kong Government had consulted the Medical Council of Hong Kong, the Joint Hong Kong Medical Association, the British Medical Association's Medical Ethics Advisory Committee and the Hospital Authority. But the result suggested doctors did not regard legalizing euthanasia as a pressing issue.
Debate on euthanasia is not new to Asia. As early as 1962, the Nagayo High Court in Japan had given criteria for lawful active euthanasia in the wake of the Yamanouchi case. It concerned a son killed his father who had been paralyzed and bed-ridden for about five years after a stroke. The court subsequently concluded that if six conditions 14 should all being fulfilled, the death should be admitted as lawful euthanasia. But there were only seven cases up to 1997 that might be considered as active euthanasia, and none were able to fulfill the criteria.
A survey conducted in 1996 revealed that nearly 70 percent of Japanese approve of euthanasia, and most of them said it must have the patients' consent 15. The Japanese newspaper Mainichi Shimbun conducted a poll in late August and early September 1996 among 4,236 adults across Japan, of whom 67 percent were supportive of voluntary euthanasia. The survey was conducted during a heated debate on euthanasia after the mercy killing of a terminal cancer patient at a Kyoto hospital earlier that year.
Fifty-eight year-old Dr. Yoshihiro Yamanaka, a surgeon at Keihoku Hospital in Kyoto Prefecture, admitted he had inject an overdose of a muscle relaxant into a 48-year-old cancer patient in April 1996 in order to give him a smooth transition to death. He said he had obtained the patient's consent. The man was suffering from stomach cancer, and the cancer was said to have spread throughout the patient's body. It was reported that the patient's wife had asked Dr Yamanaka not to prolong her husband's life. However, clear consent for euthanasia, even from the family, was not given 16. Yamanaka was dismissed as director of the local public hospital and was charged with murder.
Dr Yamanaka also admitted to several other mercy killings over the past 10 years, although he later retracted the statement saying he administered large doses of morphine in these cases only to relieve the suffering of his patients.
Japanese prosecutors, on 7 November 1994, sought a three-year sentence for a doctor who gave a lethal injection to a terminally ill cancer patient - the first time a doctor in Japan faced criminal charges for euthanasia. The case before the Yokohama District Court rekindled debate on euthanasia after decades of silence. The 38-year-old doctor, Masahito Tokunaga, was accused of behavior that betrayed the nation's faith in doctors by injecting a fatal dose of potassium chloride into a 58-year-old cancer patient at Tokai University Hospital in April 1991. Tokunaga's lawyers argued the doctor acted to make the patient's passing easier upon requests by the patient's family.
The Japan Society for Dying with Dignity survey to its more-than-80,000 members showed that over 90 percent of physicians would complied with patient's Living Will, and none have been prosecuted. There is no formal law that decriminalizes passive euthanasia, but there is a law banning assisted suicide. Thus, although passive euthanasia has become accessible and acceptable, the issue is not formally and properly discussed, and the situation is less transparent than in other countries. And the practice goes on.
In Japan, the term "dignified death" has been largely understood as a euphemism for passive euthanasia. Physician assisted suicide is discouraged, despite court rulings from early times giving criteria for which physician assisted suicide will not be considered assisted killing.
A district court on 11 April 1997 gave a suspended sentence to an 84-year-old man for the requested killing of his 76-year-old wife. The ailing wife had depression and he thought he had a heart disease. They had decided to die together but his suicide was unsuccessful. A senior citizen's hospital in Sakai City gave a 78-year-old dignified death treatment withdrawal by forcing the family to sign a document of approval in January 1997. Another case occurred around the same time in Kyoto, in which the patient's nutrition was stopped and the decision made solely by the hospital staff.
The Japan society has dropped its effort to pass a bill, having been unsuccessful during the 1980s, but everything seems to suggest a lack of due regulation, democratic control of physician, hospital ethics - even the fact that passive euthanasia has become deregulated. On February 1997, the family of a deceased physician even sued Niigata University Hospital for secretly giving chemotherapy to the patient who had cancer but had expressed a wish not to undergo any heroic treatment based on his professional opinion as a physician. The physician had been trained in Niigata University Hospital.
In the south of Asia, Edgar Avila, one of the youngest Congressmen in Philippines, proposed a euthanasia law in 1996 17. The law allows both voluntary euthanasia and passive euthanasia, and in which the patient's relatives or legal guardians can also direct the doctors in writing to withhold life-sustaining measures. Avila argues that the helpless, hopeless patients should be allowed to exercise their right to die. He claims that euthanasia is a right that belongs to individual, not the state. The House committee has endorsed the proposed law for approval.
In Singapore, a right-to-die law for terminally ill patients was introduced in 1995. Patients over 21 can have the choice to be taken off life-support systems if three doctors certify that he or she is terminally ill. However, the Singapore Government sought not to legalize euthanasia, but to give terminally ill patients the right to die, in terms of a right to make a Living Will.
The acceptance and tolerance of passive euthanasia in Asia are based upon the Oriental view on life and death. Living and dying are both seen as natural process and must follow the natural way. This is consistent with the Oriental religious teachings that letting go is key in resolving the miseries in life, including death.
This article was published in Voluntary Euthanasia Society of Scotland Newsletter /July 1998
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1 Throughout the evolution of Chinese Marxism, political struggles played a direct role in the formulation and discussion of philosophical positions. Humanism, or rendaozhuyi in Chinese, thus has been in opposition to Maoism, especially in the 1950s and 1960s because it is a broad term under which a variety of perspectives could unite. After Mao's death in 1976, those Marxists who criticizes the Communist Party are also humanists. Some of them decry the alienation of people from leaders caused by the party's dictatorship. Others participate in the growth of a new movement, 'subjectivism', that centering on the autonomy of all individuals as possible and desirable. Among the others, Wang Ruoshui, a former editor of the official newspaper People's Daily and one of the leading reform theorists accepts the premise (he never tried to prove it) that there are universal human needs. The most basic of those needs is self-realization in an all-round, free manner. From this premise, he derives a standard to judge acts or policies. Good acts or policies foster the satisfaction of basic needs, bad ones cause individuals to feel alienated or separated from their natures. Wang criticizes the Communist Party's dictatorship, which in the 1980s has fostered alienation in the Chinese people. (See, for example, Donald Munro, Chinese Marxism, © Routledge 1997, firstname.lastname@example.org). The concept of alienation in the Marxist sense is the alienation of labor in the capitalist relationship of production. The Chinese humanist Marxism frees the Marxist concept of alienation from the historical context of criticizing capitalist modernity, and turns this concept into a critique of Mao's socialism, exactly as the critique of religion by Western humanism after the Renaissance. The Chinese humanist Marxism's critique of Mao's socialism expedited the 'secular' movement in Chinese society: the development of the capitalist market process. Deng Xiao-ping, however, stresses that these criticisms are not on the right track ideologically, and humanism could not be separated from the particular context. And these erroneous trends could be corrected only by reinstating socialism spiritual civilization, which chiefly refers to communism and patriotism. (See Concerning problems on the ideological front, 17 July 1981, in Selected works of Deng Xiao-ping (1975-1982), Beijing: Foreign languages press, 1984, p.367-371; and The Party's urgent tasks on organization and ideological front, 12 October 1983, in Deng Xiao-ping wenxuan, Beijing: Renmin chubanshe, 1993, p. 36-48.) Go Back
2South China Morning Post, 21 March 1994. Go Back
3AFP, 14 Jan 1998. Go Back
4Hong Kong China News Agency, 8 November 1994. Go Back
5The New China News Agency (Xinhua), 16 March 1995. Go Back
6Beijing Evening News, 23 February 1995 Go Back
7The New China News Agency (Xinhua), 14 March 1996. Go Back
8Sing Tao Daily, 12 November 1997, p. A8. Go Back
9United Daily News, 26 January 1996. Go Back
10Chin, Michelle., Guidelines on right to die dropped, South China Morning Post, 21 June 1996. Go Back
11Sinclair, Kevin., Brave decision to legalize euthanasia, South China Morning Post, 27 January 1997. Go Back
12The Northern Australia Euthanasia Law was overturned in March 1997. Go Back
13Views on mercy deaths, South China Morning Post, 29 June 1995. Go Back
14They are (1) The patient's condition must be a terminal one with no hope of recovery and death imminent. (2) The patient is being forced to endure unbearable pain. (3) Euthanasia must have the purpose of alleviating the patient's suffering. (4) Euthanasia can only be undertaken at the request or with the permission of the patient. (5) A doctor must perform the task of euthanasia. This requirement is that a doctor will provide euthanasia. When it is not available, special circumstances could be recognized. (6) The method of euthanasia must be ethically acceptable. Go Back
15The New China News Agency (Xinhua), 2 October 1996. Go Back
16Clark, Tanya., Cancer doctor to be quizzed on mercy killing, South China Morning Post, 11 June 1996. Go Back
17Robles, R., Law will give terminally ill right to die, South China Morning Post, 27 March 1997. Go Back
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