29 January 2000

Facing Death with Positive Attitude

(Keywords: euthanasia, death education, withholding futile therapies)

            The definition given by our top health official lately on "euthanasia" has served well to clear the air.

            To dismiss any misnomer and misunderstanding, the Secretary for Health and Welfare told the Legislative Council this week squarely that euthanasia should be defined as "a deliberate act with the primary intention of ending the life of an individual, as part of the medical care offered". More, there is no distinction between "active" and "passive" euthanasia. In any case, euthanasia is currently not acceptable.

This view is in line with that of the World Medical Assembly and local health care professional bodies.

In fact, many lend support to the so-called "passive euthanasia" merely due to mixing it up with "withholding futile therapies from the dying, which aim only to prolong life". The latter is to avoid artificial prolongation of life and allow death from natural causes, rather than deliberate termination of life, is widely accepted legally and ethically worldwide. 

Whilst the Administration has no intention to legalise euthanasia at the moment, the Secretary promised that there would be further discussion and consultation with the public.

            Such open approach must be applauded. Yet, it would not be fruitful to discuss euthanasia without first addressing two basic yet crucial issues: death education, and reasons for people to opt for euthanasia.

            The fear of pain or intolerable physical symptoms; depression or anxiety over financial other burdens imposed onto their families; lacking sense of self-dignity are major reasons for dying patients asking for euthanasia. Yet, modern medicine do  enable effective pain and symptom management for most dying patients. More, holistic palliative care, with multi-disciplinary approach, could help the patients and their families to address their depression and worries, so as to enable them to add "life to days" when "days cannot be added to life".

            Experience from frontline workers revealed that being given the alternative of access to hospice care, most patients would not consider euthanasia.

            The taboo of talking about death, especially in the Chinese community, is often the stumbling block for people to enjoy and lead a meaningful and non-regrettable life till the unavoidable end.  In fact, such taboo is also the root of grievances and depression for the families that surface after the death of their beloved. Things as simple as not knowing what type of funeral ceremony or music their beloved wanted could well be a life-long regret for many. The disturbance of not knowing their beloved's death wishes, or not letting them choose the way of living in their last few months or days, simply due to refraining from addressing the issue of death, could linger indefinitely.

            As we approach of the Lunar New Year -- a time of auspiciousness, any utterance related to death would be forbidden. Yet, only if people accept death is but a natural process of life, could they succeed in fighting against the  haunt of death. After all, the "five facets of good fortune" that commonly accompany tradition Chinese well wishing include "good and dignified death". 

            It is, therefore, imperative that in the discussion about euthanasia, the public has to be educated that there is always the better alternative in hospice care. More, it is time for us to break the taboo and encourage frank discussion on death in the public at all ages. 

            Should our society value human life and dignity, we should invest to ensure adequate access to hospice care for all those in their life twilight. Our various health care professionals too should also equip themselves with at least the knowledge about when and how to put their patients under hospice service.

(Hongkong Standard)