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Allowing people to die with dignity
By Chiang Sheng 江盛
Thursday, Jun 10, 2010, Page 8
While answering questions in the legislature recently,
Department of Health Minister Yaung Chih-liang (楊志良) said that putting
terminally ill cancer patients on ventilators or giving them electric shock
defibrillation is a waste of life and medical resources. He talked about the
issue from a medical perspective, but there is more to it than that. Since Yaung
approached the question from a utilitarian standpoint, testing the public’s
reaction by raising the matter of medical resources, the backlash from his
political opponents and those who seek to uphold the dignity of life was quite
predictable. In the US, President Barack Obama’s push for a national health
insurance system faced a similar reaction from Republican opponents, who accused
him of pushing to take patients off life support and promoting euthanasia.
When former minister of justice Wang Ching-feng (王清峰) resigned over her
opposition to the death penalty, her decision actually resulted in more
executions — and more quickly, than would otherwise have been the case. Yaung’s
off-the-cuff remarks about the complicated issue of how to treat the terminally
ill may likewise produce the opposite effect.
Although Yaung referred to terminal cancer patients, they are not the only ones
nearing the end of their life. The case of Liao Feng-teh (廖風德) comes to mind.
Liao — President Ma Ying-jeou’s (馬英九) choice for minister of the interior when
he won the elections in 2008 — died of heart failure a few days before Ma’s
inauguration. Doctors tried for five hours to resuscitate him, despite his
having been declared dead on arrival at the hospital. The futility of this drama
is another example of how unwilling society and the healthcare system are to
break with the notion of the absolute sanctity of life.
Modern medical resources are very expensive and in limited supply. Although
medical ethics calls for the just and reasonable distribution of available
resources, it is still common for terminal patients to be given emergency
treatment, put on life support, injected with tranquilizers to make them sleep,
given antibiotics and cardiac stimulants, and put in intensive care units where
they are separated from their families and kept alive by any means available.
Put simply, the failure of patients to make a living will, their families’
unrealistic expectations and doctors who are unwilling to communicate or don’t
do it very well, are all factors that together create such everyday tragedies.
Not many terminal patients want to die, but there are those who feel their lives
no longer have any quality or dignity and wish to end their suffering. No
advancement in medical technology can improve their predicament. Worse,
excessive medical treatment leaves them in the tragic situation of not being
able to die with dignity. A number of doctors around the world, including
Taiwan, have admitted to supplying patients with lethal doses of sedatives and
painkillers, but these are all veiled in secrecy and usually, only family
members of doctors have access to this “service.” Physician-assisted suicide is
rarely discussed in public. People who wish to die quietly can only do so if
they are lucky enough to have the right connections.
Taiwan’s legal system, social structure and healthcare system are still
immature. The right to die with dignity requires a lot of knowledge, debate and
public effort. If the true face of death remains hidden and if the terminally
ill are all given emergency treatment whatever their situation, including
needlessly applying extra-corporeal membrane oxygenation and undergoing magnetic
resonance imaging, as was done with Liao, the financial pressures forcing up
premium rates in the second-generation health insurance scheme will soon bring
about an even costlier third-generation scheme.
Can people be allowed the right to die? If respect for patient autonomy is the
supreme principle of medical ethics, why can’t we be permitted to end our own
lives when the time comes? If those who attempt suicide are not punished under
the law, but we are only given a watered-down right to die, what kind of a right
is that, and how can we call ourselves a free nation?
Utilitarianism, as expounded by 19th-century philosophers Jeremy Bentham and
John Stewart Mill, calls on people to act so as to produce the greatest
happiness for the greatest number of people. This school of thought has plenty
of adherents in Taiwan, including Yaung. But what exactly is the greatest
happiness for the greatest number of people in relation to the right to die? For
a definition, perhaps we can look to Princeton University bioethics professor
Peter Singer, who wrote: “During the next 35 years, the traditional view of the
sanctity of human life will collapse under pressure from scientific,
technological and demographic developments. By 2040, it may be that only a rump
of hardcore, know-nothing religious fundamentalists will defend the view that
every human life, from conception to death, is sacrosanct.”
An unwillingness to accept death is the ethical and cultural mainstream here.
Taiwan does not have natural death acts like in the US, nor does it have an
equivalent of the US’ Patient Self-Determination Act. It does not have legal
euthanasia, like the Netherlands and Belgium, nor does it permit
physician-assisted suicide, like Oregon and Washington state, or have legal
provisions like those in the UK, where family members who help patients go to
Switzerland to seek assistance in dying do not face prosecution.
Bengali poet Rabindranath Tagore once wrote: “Let life be beautiful like summer
flowers and death like autumn leaves.” Taiwan has a long way to go before death
can have its proper beauty, and the main reason is society has not pressed for
legislation to uphold the right to die.
Chiang Sheng is an attending physician in obstetrics and
gynecology at Mackay Memorial Hospital.
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