VOLUNTARY EUTHANASIA SOCIETY OF SCOTLAND NEWSLETTER / JULY 1998

The Asian way on death

Eric Tsang

We are remarkably fortunate in this issue to have a broad-based review of right-to-die issues as they are developing in a part of the world that all too frequently remains a mystery. Eric Tsang is an editor for the Hong Kong Economic Journal - a prestigious financial daily newspaper in Hong Kong. He graduated from the City University of Hong Kong in 1994 with a B.A. Honours degree in Public and Social Administration. In 1992, he was diagnosed as having Non-Hodgkin’s lymphoma in his stomach, and received chemotherapy following surgery. His  historical overview is followed by some footnotes that help understanding of the ideological struggle in which euthanasia has been debated.

The Oriental view on euthanasia reflects the Oriental view on life and death. Oriental views on life stress 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 of 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 people over 65 in China is 6.5 percent, will be 10 percent by year 2000, and 25 percent by 2050.(3)

Later in 1994, at an academic 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 favouring a euthanasia policy. 73 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 had 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 costs 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 with 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 ago. The elderly lady, Wang Chao Hsi-nian, said she would also write to President Lee Teng-hui asking for sympathy for family members of persons in a vegetatative 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 very little public interest in the issue - the debate did not stop. One writer(11) argues 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 in 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 killing his father who had been paralysed 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 the Japanese approve of euthanasia, and most of them said it must have the patient’s consent.(15) The Japanese newspaper Mainichi Shimbun conducted a poll in late August and early September of 1996 among 4,236 adults across Japan, of whom 67 percent were supportive of v.e. The survey was conducted during a heated debate on euthanasia after the mercy killing of a terminally ill 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 injected 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 have spread throughout the patient’s body. It was reported that the patient’s wife had asked Dr Yamanaka not to prolong her husbands 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 murder.

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. Tokunagas 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’s survey to its more-than-80,000 members showed that over 90 percent of physicians would comply with the 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 formerly or 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 to be 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 sickened wife had depression and he thought he had a heart disease. They had decided to die together but his suicide was unsuccessful. A senior citizens’ 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 that 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 physicians, or 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 a 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 there in 1996.(17) The law would allow 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 helpless, hopeless patients should be allowed to exercise their right to die. He claims that euthanasia is a right that belongs to the individual, not the state. The House committee had 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 the key in resolving the miseries in life, including death.

Footnotes

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 criticized the Communist Party were also called humanists. Some of them decried the alienation of people from the leaders caused by the party’s dictatorship. Others participated in the growth of a new movement, ‘subjectivism’, that centres on the autonomy of all individuals as possible and desirable. Among 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 1980’s had fostered alienation in the Chinese people. (See, for example, Donald Munro, Chinese Marxism, Routledge 1997).

The concept of alienation in the Marxist sense is the alienation of labour in the capitalist relationship of production.  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, very similar to 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 and the development of the capitalist market process. Deng Xiao-ping, however, claims that these criticisms are not on the right track ideologically, and that humanism can not be separated from the particular contextual and social background. He goes on to claim that these erroneous trends can be corrected only by reinstating socialism spiritual civilization, which chiefly refers to communism and patriotism. (See Concerning problems on the ideological front, July 17, 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, October 12, 1983, in Deng Xiao-ping wenxuan, Beijing: Renmin chubanshe, 1993, p. 36-48.)

2. South China Morning Post, 21 March 1994.

3. AFP, 14 Jan 1998.

4. Hong Kong China News Agency, 8 November 1994.

5. The New China News Agency (Xinhua), 16 March 1995.

6. Beijing Evening News, 23 February 1995

7. The New China News Agency (Xinhua), 14 March 1996.

8. Sing Tao Daily, 12 November 1997, p. A8.

9. United Daily News, 26 January 1996.

10. Chin, Michelle., Guidelines on right to die dropped, South China Morning Post, 21 June 1996.

11. Sinclair, Kevin., Brave decision to legalize euthanasia, South China Morning Post, 27 January 1997.

12. Australia’s Northern Territory’s euthanasia law was overturned in March 1997.

13. Views on mercy deaths, South China Morning Post, 29 June 1995.

14. They 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 of, 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 morally acceptable.

15. The New China News Agency (Xinhua), 2 October 1996.

16. Clark, Tanya., Cancer doctor to be quizzed on mercy killing, South China Morning Post, 11 June 1996.

17. Robles, R., Law will give terminally ill right to die, South China Morning Post, 27 March, 1997.