Shenzhen's local legislation "Living Will" detonated the whole network, and this local legislation is extremely important. For most patients, at the last moment of life, it is often impossible to decide whether to continue the rescue. Shenzhen local legislation "living will" detonated the whole network.

Shenzhen local legislation "living will" detonated the whole network 1. When you are seriously ill and your life is coming to an end, do you want to intubate and insert instruments to get full rescue, or do you want to end your life with dignity?

Recently, Shenzhen's "avant-garde exploration" of living will legislation has aroused widespread discussion in society, which has made the public re-examine life propositions such as the right and meaning of life, the acceptance and choice of death.

According to relevant legislation, if the patient makes a pre-judgment of "Don't do unnecessary rescue", the hospital should respect the patient's wishes and let the patient spend the rest of his life peacefully. That is, my life is in my control, and it is up to me to decide whether to save me before I die.

In China's traditional concept, when the lives of relatives, especially elders, reach the last moment, people often choose to do everything possible to save them, otherwise they will be regarded as "unfilial".

Some patients are willing to lie in the intensive care unit, endure the pain and wait for the miracle, while others are unwilling to lose their dignity and bear the pain caused by excessive rescue, hoping to finish their life journey calmly and peacefully. Although the current medical technology is developed, it is not omnipotent, and there are many incurable diseases. Even if you try your best to rescue, it will only prolong the time and the quality of life of patients is worrying.

It is understandable that families with good economic conditions are willing to do their best for their parents, but for many ordinary people, they are faced with a dilemma. Continuing treatment means bearing a heavy debt burden; If you give up treatment, you may lose your tongue and be labeled as "afraid of spending money and unfilial".

Patients with advanced severe illness will inevitably lose the ability to express their wishes, and their brains, bodies and lives can only be handed over to their relatives and passively treated. This is essentially a neglect of the patient's right to decide his life and personal will. Giving patients the right to life is in line with humanitarianism and better reflects the free will of life.

Some European and American countries have given patients the right to decide their own lives by legislation. Even in some Asian countries and regions deeply influenced by Confucian filial piety culture, "death with dignity" and "filial piety culture" are no longer regarded as opposites. Singapore's founding father Lee Kuan Yew and Taiwan Province writer Qiong Yao both made living wills with dignity.

Previously, living wills were also promoted in some places in China, but only in the form of verbal encouragement and private initiative. Some medical institutions are afraid of taking risks, the demands of critically ill patients have not been fully responded, and the plight of family members has not been fully answered. Shenzhen regulates living wills from the legislative level, which responds to the pursuit of death and life dignity in modern society and helps to resolve the ethical dilemma of "being or not being" and "filial piety".

Shenzhen local legislation "living will" detonated the whole network 2 Recently, the tenth meeting of the Standing Committee of Shenzhen Municipal People's Congress voted to pass the revised draft of the Medical Regulations of Shenzhen Special Economic Zone, which revised and improved China's first local medical "Basic Law" implemented from 20 17 to 1 year. Among them, Article 78 has made a bold breakthrough in the "dying decision", stipulating that if the patient makes a will "not to do unnecessary rescue", the hospital should respect his wishes and let the patient walk the last journey calmly, so as to write the living will into local regulations.

This local legislation is very important. For most patients, at the last moment of life, it is often impossible to decide whether to continue the rescue. Many times, patients struggle in pain and spend a lot of money, but their families are still asking the hospital to continue to maintain a life without quality and hope until the last moment.

To tell the truth, this seemingly painstaking situation does not conform to the laws of medicine, and it is not necessarily the result that patients are willing to see. With this local law, patients can "make their own decisions" in the last journey of their lives, avoid the torture of unnecessary rescue, and end their lives peacefully.

In real life, some people regard "living will" as a variant of "euthanasia" Although both of them aim at ending the patient's life with less pain and taste of "dignified death", "living will" and "euthanasia" are different. The purpose of establishing "living will" is to make hospitals and doctors give up unnecessary rescue and let patients die in a more natural and peaceful state. Euthanasia requires medical staff to end the patient's life in a painless way.

In contrast, the former does not use life support systems, such as cardiopulmonary resuscitation, artificial respiration machine and other artificial equipment, which embodies the patient's independent choice of life right and makes it easier to avoid legal obstacles in front of euthanasia. At present, only the Netherlands and Belgium have passed euthanasia legislation, but the laws of most countries rarely prohibit "living wills".

China's Constitution clearly stipulates that "the state respects and protects human rights", and the Civil Code also stipulates that "natural persons have the right to life". Examining the essence of "living will" is actually to respect the medical autonomy of dying patients and protect and develop their right to life, which does not conflict with the current legal provisions.

In March this year, the National Health and Health Commission and other departments 15 jointly issued the 14th Five-Year Plan for Healthy Aging, clearly proposing to develop hospice care service, steadily expand the hospice care pilot, improve the multi-disciplinary service mode of hospice care, and improve the quality of life of the elderly and terminally ill patients. This also reflects the changes in the national policy level, and it has become the general trend to help patients die comfortably, peacefully and with dignity.

Throughout this local legislation in Shenzhen, we have taken solid steps by adhering to the spirit of law and drawing lessons from other mountains. In order to prevent this innovative system from being used by people with ulterior motives, resulting in an unfavorable situation of being "death with dignity", the Regulations specify strict conditions:

First, the patient has a clear statement; Second, there are witnesses present, "notarized or witnessed by more than two witnesses, the witnesses shall not be medical and health personnel involved in the treatment of patients"; The third is recorded in words or audio-visual. "Unless notarized, if it is in writing, it shall be signed by the testator and witnesses, and the time shall be indicated." Through the synergy of these measures, patients' voluntary will can be effectively reflected, the behavior of medical institutions can be effectively restrained, and abnormal situations can be avoided.

Generally speaking, local legislation "living will" expands the space for protecting the right to life according to law, but we should also see the deficiency from concept to legislation. At present, there are 1 294934 visitors who log on to the website of "Choice and Dignity" and 50755 registered members, but only 32 1 person has completed the "living will", most of which are concentrated in Beijing and Shanghai.

In this regard, it is necessary to strengthen publicity and let more patients know about this new thing. In addition, this kind of legislative innovation still stays at the local legislative level. In the long run, it is necessary to enter the national legislation through investigation and demonstration to provide more patients with dignified choices.

Recently, the tenth meeting of the Standing Committee of the Seventh Shenzhen Municipal People's Congress voted to adopt the revised draft of the Medical Regulations of Shenzhen Special Economic Zone (hereinafter referred to as the Regulations). Among them, Article 78 has made a bold breakthrough in the "dying decision", stipulating that if the patient makes a will "not to do unnecessary rescue", the hospital should respect his wishes and let the patient spend his last time safely. As a result, Shenzhen became the first region in China to realize the legislation of living wills.

In this regard, Jin Chenghua, director and associate professor of the International Medical Law Research Center of Shanghai University Law School, told the reporter of China Times: "The significance of the pilot legislation of Shenzhen's living will lies in two aspects: concept guidance and system innovation. From the institutional level to promote the change of traditional ideas, patients' right to informed consent at the end of their lives has been respected and guaranteed by law, which is the first case in China and has great symbolic significance. It provides a good example for theoretical research and system design in related fields in China in the future. "

However, Jin Chenghua also warned: "A living will and even a dignified death is not a simple legal issue. It involves basic human rights such as people's right to life and health, and it will also lead to in-depth thinking in the field of philosophy. In addition, its institutionalization should cover the interests and opinions of all sectors of society. Without sufficient argumentation and recognition, hasty legislative Council will lead to more social contradictions and disputes. Therefore, China has always adopted a more cautious attitude. "

Shenzhen tests "living will"

The so-called "living will" is a concept put forward in view of the widespread over-rescue and over-medical treatment before death. Previously, this concept was often tested by the public, and this time Shenzhen introduced it into the law, which was a major breakthrough in safeguarding "human rights."

To this end, the reporter of China Times visited the inpatient department of Shenzhen People's Hospital and found that many patients and their families told reporters, "I have this demand and want to experience it for myself!" But many patients think that "for the sake of my family, I will still choose overtreatment to prolong my life."

Article 78 of the revised Regulations stipulates "living will": If a patient or his close relatives provide a living will that meets the following conditions, medical institutions should respect the patient's living will when implementing medical measures for incurable injury or death: whether to take traumatic rescue measures such as intubation and cardiopulmonary resuscitation, whether to use life support system, and whether to continue to treat the primary disease.

Moreover, the "Regulations" clearly require the form and manner of living wills. In content, there must be true expression of meaning; Formal notarization is required or witnessed by more than two witnesses, who cannot be medical and health personnel involved in treatment. Moreover, the patient's signature is required, and the time is indicated in writing or audio and video recording to ensure the authenticity of the patient's wishes. This explicit requirement ensures the authenticity and validity of such wills and avoids subsequent disputes.

At present, Shenzhen Notary Office has handled three cases of notarization of living wills, which ensured that the wishes of the parties were respected and implemented, and summed up useful experience in judicial practice, which ensured the implementation of the Medical Regulations of Shenzhen Special Economic Zone.

Hu Jun, a lawyer of Beijing Yingke (Shanghai) Law Firm, said: "The living will first ensures that the patient's wishes are respected to the greatest extent and protects the patient's personal interests; Secondly, it is conducive to easing social contradictions, solving family disputes and avoiding differences of opinion among family members; Thirdly, in terms of social benefits, it helps to save medical resources, avoid excessive medical care and ineffective medical care, and transfer limited medical expenses to prevention and health care. "

Tang Shuyuan, chief researcher of Insight Times Digital Research Institute, told this reporter why the living will first entered the law in Shenzhen: "First of all, this legislation was revised on the basis of the Medical Regulations of Shenzhen Special Economic Zone, which was implemented in 20 17. At that time, this local regulation was the first "basic law" of local medical care in China, which had sufficient basis for revision;

2. Shenzhen Living Will Promotion Association was established in April, 200211July. It is the second non-profit organization in China to promote living wills initiated by eight hospice care pilot units in Shenzhen, and has accumulated certain practical experience. Third, the Shenzhen Special Economic Zone has the economic and social conditions to try first, so people can accept and promote the new concept of "living will" more easily and quickly.

Can it be promoted nationwide?

In fact, "living will" is translated from the word "living will", which was first put forward by Illinois lawyer Luis Koutna in a speech to the American Euthanasia Association in 1967 and published in a legal journal in 1969.

At present, 30 countries and regions around the world have allowed the legal use of "living wills" and a series of documents with similar functions in medical treatment, such as Canada, Britain, Germany, Italy, the Netherlands, Israel, Switzerland and India. However, in some countries, "living will" is not recognized by law, such as Japan.

However, the Japanese non-governmental organization nihon song enshiky Kay (Japan Dignity Death Association) provided its members with a semi-standardized "living will" form registered with the organization, but it has no legal effect.

In this regard, Jin Chenghua also pointed out that "whether it is the western countries that legalized euthanasia in the early stage or the neighboring countries and regions such as South Korea and Taiwan Province Province that institutionalized euthanasia recently, its institutionalization is not the end of their social disputes, but has triggered more acute social disputes. This is the concern of our country. "

It is understood that the word "dignity" was written into the right to life clause in Article 1002 of the Civil Code promulgated in 2020 for the first time. "The life safety and dignity of natural persons are protected by law" is particularly striking in the personality right clause.

However, different from the western individual liberalism model, in China's traditional culture, family plays an important role in patients' major medical decisions, and some information that is not conducive to patients' illness is often given priority by doctors based on the principle of protection, thus depriving them of their right to make independent decisions. The "living will" is to let patients regain their rights and dignity. Previously, it has been popularized in domestic folks for many years, but there are few cases that can really be implemented.

As early as 2006, Luo Diandian, the daughter of Luo Ruiqing, the founding general, founded the first public welfare website "Choice and Dignity" in China, promoting "Death with Dignity" and "Living Will". In 2009, the commonweal website "Choice and Dignity" published the first edition of China's living will-"My Five Wishes". On the basis of this website, the Beijing Living Will Promotion Association was established on 20 13, becoming the first social organization to promote living wills.

Then, in April of 20021year, Shenzhen Living Will Promotion Association was established, becoming the second non-profit organization in China to promote living wills.

In addition, a few old-age care institutions and hospitals in Nanjing and Guangzhou also explored and launched the "living will" project in the early years. Although some patients and their families accept it, many patients and their families find it unacceptable.

And in practice, because it has no legal effect, when patients' wishes conflict with their family members' opinions, medical institutions and doctors sometimes turn patients' wishes into illegal "empty talk" and "living wills", and the implementation is not smooth, so as to avoid huge risks such as civil tort claims or administrative penalties by competent departments.

Then, will Shenzhen's "living will" be piloted nationwide? Jin Chenghua believes that it is difficult to implement it nationwide. "First of all, issues related to hospice care such as' living will' and' death with dignity' involve many disciplines such as law, medicine, philosophy, sociology, ethics and psychology. However, the current theoretical research is not deep enough, especially the cross-integration research between disciplines is relatively insufficient; Secondly, China is a vast country with great economic, social and cultural differences.

Based on the difference of education level and their own environment, residents' acceptance of related ideas is different. Therefore, the legislative pilot in Shenzhen can be used as a reference for other regions, but it is not necessarily a unified standard of "universal application". "

Therefore, Jin Chenghua suggested: "Domestic theoretical circles should start interdisciplinary research, such as law, medicine, philosophy, sociology, ethics, psychology and so on. Vigorously cultivate research platforms and talents of medical and health law, public health law and international health law led by law schools and medical schools in colleges and universities. At the same time, with Shenzhen as the starting point, other areas with conditions can carry out local legislation pilot projects according to the actual situation in the region.

Our long-term goal should be to establish a Chinese hospice care bill. According to the new requirements of the new era, both theoretical research and system design should adopt an objective, rational and prudent attitude. On the other hand, we should pay attention to the new problems and contradictions in the process of system implementation, so as to provide reference for constructing the system model with China characteristics. "