- Dr Cong Yali(1996C)
Dept. of Social & Human Science, Beijing Medical University,
38 XueYuan Rd, Beijing 100083, CHINA
On 23 June, 1986, Xia Suwen, a 59 year old female, was taken to Han Zhong hospital (Shan Xi province) for infectious diseases, because she suffered from ascites, cirrhosis of the liver. Even though her condition turned a little better after several days treatment, the condition became worse on 27 June and she kept on crying that, "It's so painful that I don't want to live". After Wang MingCheng, one of her sons, learnt that his mother's condition was hopeless on 28 June, he asked Dr. Pu Liansheng, the physician in charge, to inject some medication to let his mother die without pain, but Dr. Pu refused at first. After Wang implored Dr. Pu several times, Dr. Pu was persuaded to let trainee nurse inject 100 ml compound at 9 a.m. on 28 June, before which Wang signed a formal letter saying "Family member asks for euthanasia, Son: Wang MingCheng". Before Dr. Pu went off he ordered the night shift doctor to give a further injection if Xia didn't die. At 3am Xia was injected with a further 75ml of wintermin compound and died at 5am on 29 June, 1986.
Other children of Xia Suwen sued Dr. Pu for killing their mother, so Dr. Pu and Wang MingCheng were taken into custody on 20 Sept and 30 Sept, 1986, respectively. Pu and Wang were released on bail to await trial on 20 Dec and 24 Dec 1986. On 17 Aug and 29 Aug, 1987, Pu and Wang were seized again by the People's Procuratorate of Han Zhong, and the People's Court decided to release them on bail again on 23 September.
On 15 March, 1990, nearly four years after the incident, the People's Court of Han Zhong held the court. Following the statement from the public prosecutor that the use of Wintermin compound, which should normally be used carefully or avoided, violated the Criminal law Rule 132 of the people's Republic of China, and they committed the offense of intentional homicide, there was a loud roar of discontent from the public gallery. The court continued on 17 March, with the expert conclusion from the Malpractice Appraisal Committee of Sha Xoi Province, of 10 July, 1989, "Wintermin compound was not the direct cause of Xia's death, but it did deepen the coma of Xia which promoted death. The debate began in court, and the defense lawyer Zhang Zanning made a successful justification for the defendants. On 17 May, 1991, the first judgment was declared, "Even though the wintermin compound hastened Xia's death the dose was not excessive, and circumstances were not severe enough to constitute criminality", and they were both found "not guilty". The final judgment by the Intermediate People's Court of Han Zhong Prefecture rejected the appeal of the plaintiff (the People's procuratorate of Han Zhong) and upheld the first judgment.
The first euthanasia case was so much a test case before the public, and debatable, that it took five years to make the final judgment. It shows a change of people's attitude towards death. Chinese people are concerned about this world and avoid mentioning death due to the affection of Confucianism, so there is scarcely any open discussion of death. However, this case made people face death and talk about it objectively. In large cities, especially in Beijing, many approve of euthanasia. A survey by the Chinese Academy of Medical Science found 95% of medical workers approve of it (Table 1). But we must admit that this questionnaire represents only a small portion of the Chinese people, and 80% of the populations are peasants which are more subject to Confucianism.
Table 1: Attitudes to euthanasia (%)
Values: approve; disapprove; no idea; not clear
Hospital managers (N=133) 92.5 3.8 3.0 0.7
Doctor (N=123) 96.8 1.6 1.6 0
Nurse (N=102) 98.0 1.0 1.0 0
Medical technician (N=89) 93.3 2.2 4.5 0
Total (N=447) 95.1 2.2 2.5 0.2
There are two main characteristics of euthanasia in China:
1) The status of the family is more important than the patient's right
In China consent for an operation must be agreed and signed by a family member, not the patient himself, which shows the affect of the long history of the patriarchal clan system. Unlike the west, people and society don't pay much attention to the autonomy of the patient, even if the patient who is in great pain asks to die without pain. Usually the patient doesn't think of such behaviour as an insult to his dignity, which is maybe an intrinsic difference between West and East.
2) Filial piety is still regarded as the basic moral standard
Filial piety, such as the responsibility of children to support their parents until they die, plays an important role in Chinese society. When parents are ill, children should do their best to cure their parents, or else they will be considered unfilial. Considering 80% of Chinese are poor peasants, who cannot afford expensive medical technology use by a hospital, children may prefer to take their parents home and let them die naturally, rather than injecting them with medication which may hasten death. However in the cities many people have free medical care so children may ask the doctor to keep their parents alive as long as possible whatever the technology, because they think it shows love for parents. Even if the doctor thinks it is useless, they have no right to stop treatment. Prof. Liu Xiuwen, who works in the ICU of the first teaching hospital of Beijing Medical University, commented that it is unfair that the doctor cannot suggest to the family members to stop medical treatment when the situation is hopeless and it is a waste of expensive medical treatment.
From the first euthanasia legal case we can see a gradual change in people's attitudes, and some increase in the rights of individuals although Confucianism still has effects on Chinese people. In practice euthanasia is often done in secret. In my opinion, euthanasia is a reasonable choice for those patients who are in great pain and have no hope of a cure, providing it is upon the patient's request. There are many views of death in different cultures, but modern medicine pushes all of us to a similar situation. As members of the same species we have some common ideas, such as to dislike suffering, wanting to live as long as possible. I believe we can come to some common understanding which will constitute a base for universal bioethics, in which there is an ethical foundation for euthanasia.
1. J. Chinese Medical Ethics No. 5, 6 (1990); No. 4 (1992).
2. Collection of papers from the First Conference on Euthanasia, Social, Ethical and Legal Problems.