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Discussion on Birth, Death and Dying

Han: The first speaker is Prof. Lee from Korea. Are there any questions?

Singer: I am from Princeton University. I have a question for you. You compared the death of the embryos with the murder of an adult human. So I wonder with adults we are prepared to spend a lot of money to try to prolong their lives if they want to live. So if someone is 70 years old and is ill, we will do medical research to try to cure their diseases and help them live longer. With the 75% of embryos that do not make it to become babies, would you also propose that we should engage in a lot of medical research to try to make sure that this 75% of embryos that now die survive to birth. Do you think that is just as important as to try to help older people to live longer?

Lee: I thought that Peter Singer would ask this question. I think that Peter Singer is a great bioethics expert, and he studied for a long time philosophy and bioethics. I studied chemistry and after that I studied the history of science and I got interested in the problems raised by science and technology. So I was hesitant in giving this presentation on embryo research. I read your book on embryo experimentation. And you ask a very precise question about embryo experimentation, which you support. I am not able to answer such a question because it's very difficult to answer such a logical question. Can I finish my answer?

Singer: Thank you for your kind remarks. But I think if you have trouble in answering it then perhaps even you do not really think that the death of a pre-embryo is not as serious as the death of an adult human. That's the point of my question.

Doering: First I would like to congratulate you for the very courageous speech that you gave. And I think my comment may be helpful in pointing out the different views within the room. I think we have heard two very different discourses. They are tips of the iceberg. One is what you refer to as bioethics mainstream. The other is a glimpse of the history and philosophy of science and general hesitation in the way that the hopes of science and technology are. But I think these two do not really communicate with each other. One way we can progress sis proper use of language. For example if you use the term murder, it wouldn't be helpful; if you call it intentional killing it much more rational and may make communication between the two views easier.

Lee: Well, I intentionally used the word "murder." We can use intentional killing. But I do not always feel comfortable in using certain kinds of words. We can pretend to be neutral, but we human beings cannot be neutral so I intentionally used the term "murder".

Doering: Do you find it unethical?

Lee: Yes, because if we use the other term. We attempt to be neutral but we cannot be neutral. So I intentionally used the word "murder".

Han: Thank you Prof. Lee. Are there any questions for Dr. Sahin Aksoy?

Hsin: You mentioned that 100% of nurses are well trained in terminal care. I was surprised that so many are trained. So I was wondering what is your definition of euthanasia? Is it different from natural death? Did you give a good definition of the term euthanasia when you ask that question to nurses?

Sahin Aksoy: Most doctors do not want to be involved if a patient wants to die. The majority does not want them. Traditionally nurses are known as white angels and they do not want to be seen as angels of death.

Leavitt: Do you think anyone can know in advance what they are going to want when they are terminally ill? Sometimes we say we would want this or that, but I really do not know. I wonder what the value of surveys asking people when they are young and healthy about what they want when they are old or sick?

Sahin Aksoy: Maybe that is true. That is what advance directives are all about. But still if there is an advanced directive it is some guidance.

Han: Thank you. The next paper is by Dena Hsin and Darryl Macer. Are there any questions for Ms. Hsin.

Leavitt: I do have a critical comment. We have in our university a Master's Program in gerontology; which is not geriatrics. Geriatrics studies sick old people; gerontology is the study of aging, which does not necessarily deal with illness or dying. Maybe there should be more attention placed on older people towards life. But I think that there is no necessity to treat death specifically in relationship to older people. Some older people live for a long time and a lot of younger people die. I think there should be more emphasis to be put on life for older people. Why do you pick 60 is the age when seniors turn old? I would have thought it would be 80 or 90?

Hsin: The second question is easier to answer. That is according to the WHO definition of how old seniors should be, at 65 years of age. Still in many countries they retire at 60. As for you first question on why I want to talk about life and death. Let me say that in Taiwan, we now have national health insurance. My background is nursing and actually I now teach the subject. So I don't have experience in the hospital after the national health insurance was implemented. Most old people would go to the hospital in their last moment. Before they could pass away very peacefully with their family. And this is another problem. In Chinese society, old people are revered. So people would tend to try to prolong their parents' lives whatever the cost may be. Even the doctor hesitates in suggesting to the family that maybe it is time to stop because there may still be a chance to prolong life. And about ontology, according to Kant when people make an effort to try to survive, it's a kind of higher standard of moral thinking. If people are tired, they can accept the natural course of life. There is progression of generations. It is not necessary. Like my colleagues in Japan report that doctors there always tell the patient "Gambatte". But the patient is really tired, really exhausted. The patient just wants a quick dying process.

Hwang Jeong: Hello I am a medical doctor from Korea. We have a similar situation in Korea. Are there any differences in the way seniors think about end-of-life care based on gender?

Hsin: I have not finished analyzing all the data yet. Unfortunately, there is a different relationship in terms of gender, or different ages among the elderly. But at this moment, according to my impression during the interviews that I gave it is not that different. I will give you a more concrete answer a year later.

Hwang Jeong: In Korea, the women are more open to talk.

Hsin: Maybe women are more open in Taiwan too.

Han: Because of the time limit we need to proceed to the next presentation.

Oobayashi: Now I will take over the chairing. The next speaker is a psychiatrist from Japan, Dr. Ito.

Oobayashi: Are there any questions?

Anstey: You talked about free will, respecting the patient's free will in this case. I am a little confused with this case though. Wasn't this case where the patient was forcibly put in hospital, so would he be competent. So is the patient's free will being violated? Is it the patient who can make an autonomous decision? What do you think is the attitude of Asian people towards this kind of case?

Ito: I think the patient's competency is not complete because he was a patient with schizophrenia. He has some delusions, like thinking he was immortal. So his will is not completely free.

Anstey: If he didn't have free will, can you call this suicide or assisted suicide?

Ito: I myself couldn't force treatment on him.

Oobayashi: Thank you. Are there any questions for Hsui-I Yang?

Ko: You mentioned that one of the pitfalls of this act was that it cultivated debate on death and dying. I'm not sure about that because you said that talking about death is a taboo in Taiwan. And it maybe the case that by using different terms for death, this is a way by which people could indirectly talk about it? Can you call it a euphemism for death? Do you have any substantial reasons in thinking that this is a myth? Is there some background belief?

Yang: Yes. I think that we are probably trying to create a new term to make it more comfortable to talk about this very unpleasant subject. But the truth is that the recommendation originally proposed a natural death act. So there is no objection against natural death. I was privileged to participate in the legislative process. At that time, we wanted to make it clear that we think natural death is a right. As Dena Hsin pointed out before, Chinese think that it is natural to die. It is not something to be afraid of. But that's not the case. Because I was told that death is something we shouldn't encourage, that is why we shouldn't put the term "death" in a formal act or law.

Oobayashi: Thank you. The next paper is by Dr. Younsek Koh. Are there any questions?

Leavitt: I would like to thank you first in mentioning the insensitivity of caregivers as an ethical problem. Too many people think that bioethics is cloning, abortion, euthanasia and other high-faluting issues and they don't realize that these types of issues are real medical ethics dilemmas in practice everyday. I don't think medical schools that teach students and nurses are the best way to solve that problem.

Koh: This dilemma is very important to face in medical education. Although nurses may find this case very difficult, generally they can deal with the situation well. But the level of standard of ethical behavior depends on ethical behavior. It could be considered as ethical or acceptable. So when we evaluate individual cases, we found that we still needed to educate them. Because there is erroneous behavior that can be corrected when we try to raise their level of standard of ethical thinking. And another factor is, as you know, to establish a society to improve medical ethics in medical colleges takes a long time. We are just at the beginning stage. We are planning a medical educational system in individual hospitals not just medical schools. I believe we could improve the ethical situation in medical schools in the way I mentioned.

Oobayashi: Thank you. The next speaker is Dr. Hamano. I am afraid there is no time left for questions.

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Eubios Ethics Institute | Book List | TOP - Asian Bioethics in the 21st Century