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MOHD ZULFADLI BIN ZAINAL AZMAN
2018456454

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By Preeti Jha
BBC News

New Zealand has voted to legalise euthanasia in what campaigners have called "a victory for compassion and kindness".

Preliminary results showed 65.2% of voters supported the End of Life Choice Act coming into force as a new law.

The law will allow terminally ill people with less than six months to live the opportunity to choose assisted dying if approved by two doctors.

Its opponents say the law lacks adequate safeguards.

The referendum results announced on Friday do not include an estimated 480,000 special votes, including overseas ballots, so the final outcome will not be confirmed until 6 November. But with such strong support, the decision is not expected to change.

The referendum is binding and the law is expected to come into effect in November 2021.

It will see New Zealand join a small group of countries, including the Netherlands and Canada, which allow euthanasia.

The referendum on assisted dying was held alongside the general election earlier this month. In a separate non-binding referendum held at the same time, New Zealanders narrowly rejected a proposal to legalise recreational cannabis.

The preliminary results on the cannabis vote was 53.1% no and 46.1% yes - though this result may be subject to change when the special votes are counted.

What has the reaction been?

The "yes" verdict had been anticipated after polls suggested strong public support for the law, which was also backed by Prime Minister Jacinda Ardern and the opposition leader, Judith Collins.

But it was the result of an emotional, years-long campaign with strong views on both sides of the debate.

For Matt Vickers, who took on his late wife Lecretia Seales' fight to legalise assisted dying, the result is "a victory for compassion and kindness".

"I am grateful that terminally ill New Zealanders will have a say about the ends of their lives," he told the BBC after the announcement.

Ms Seales was a lawyer who launched a legal challenge for the right to end her life with medical assistance after she was diagnosed with a brain tumour. But her case was unsuccessful and she died of her illness five years ago, aged 42.

Mr Vickers pressed on with her campaign and in 2016 his book, "Lecretia's Choice: A Story of Love, Death and the Law", was published.

The day before the result Mr Vickers told the BBC that ultimately his late wife's goal was for terminally ill people to have the choice that she was denied.

"She didn't want to die. No one does. That's a popular misconception. The problem was the choice to live had been taken away," he said. "She wanted a choice on how death happens so if things got bad she could end the suffering at the time she wanted."

Ms Seales' case went on to play a pivotal role in raising awareness about assisted dying, catalysing New Zealand politicians to address the issue.

What is the new law?

The End of Life Choice Act was passed by parliament in 2019 after years of heated parliamentary debate and a record number of public submissions.

But there was a proviso that it would first be put to a referendum, only coming into force if more than 50% of voters ticked "yes".

There are a number of criteria a person must meet to ask for assisted dying. These include:

suffering from a terminal illness that's likely to end their life within six months

showing a significant decline in physical capability

being able to make an informed decision about assisted dying

The legislation authorises a doctor or nurse to administer or prescribe a lethal dose of medication to be taken under their supervision if all the conditions are met.

The law also says a person cannot be eligible for assisted dying on the basis of advanced age, mental illness, or disability alone.

What do opponents say?

While there is widespread support for euthanasia reform, there has also been vocal opposition.

As MPs voted on the bill last year, protesters had carried placards stating "assist us to live not die" and "euthanasia is not the solution" outside parliament.

Euthanasia-Free NZ, a group that campaigned to vote "no", has said that euthanasia poses a threat to the well-being of society. Among its concerns are that the legalisation of assisted dying would contradict and undermine suicide prevention.

Others have voiced worries about people with chronic conditions potentially feeling obliged to use euthanasia to avoid being a burden on their families.

On Friday Euthanasia-Free NZ said it was "disappointed that the New Zealand public voted to pass a flawed euthanasia law". In a statement it added that parliament "could have made this law safer" by passing further amendments.

Which countries allow euthanasia?

The referendum result in New Zealand will be closely watched by advocates for and against assisted dying throughout the world.

By voting "yes" the country is joining a small group of nations and territories that have passed similar legislation.

Euthanasia is legal in Belgium, Canada, Colombia, Luxembourg and the Netherlands, while assisted suicide is permitted in Switzerland.

A number of states in the United States and the Australian state of Victoria have also made assisted dying legal.

Euthanasia is the act of deliberately ending a life to relieve suffering, while assisted suicide is the act of deliberately assisting another person to kill themselves. In contrast to euthanasia and assisted suicide, assisted dying would apply to terminally ill people only.

If you've been affected by issues in this article, help and support is available via the BBC Action Line.

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New Zealand euthanasia: Assisted dying to be legal for terminally ill people

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By Preeti Jha BBC News New Zealand has voted to legalise euthanasia in what campaigners have called "a victory for compassion and kindness". Preliminary results showed 65.2% of voters supported the End of Life Choice Act coming into force as a new law.

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As per preliminary referendum results, a majority of voters in New Zealand have voted in favour of the End of Life Choice Act 2019. As people voted in the general elections, they also had the option to vote in two referendums. One of the referendums was on cannabis legalisation and control, which over 53 per cent of the voters voted against. The second referendum asked the public to vote on whether the End of Life Choice Act 2019 should come into force.

New Zealand's prime minister Jacinda Ardern has revealed that she voted "yes" in both the referendums. Even so, Friday's preliminary results do not include over 480,000 special votes.

The final results will be declared on November 6.
So what is the End of Life Choice Act 2019?
The act is meant to give certain terminally ill people the option of requesting medical assistance to end their lives and to establish a lawful process for assisting eligible persons who are able to exercise that option.

The opponents of the Act such as the Euthanasia Free-NZ group maintain that it lacks oversight and safeguards and have pointed out issues with the eligibility criteria such as the age limit of 18 years and the "arbitrary" nature of the 6-month prognosis.
How did the Act come about?
The Act was passed in November 2019, but requires that it gets at least 50 per cent of the votes in the 2020 referendum to be effective. One of the most significant cases that shaped the debate around assisted suicide in New Zealand was of a lawyer Lecretia Seales who was diagnosed with brain cancer in 2011. After Seales' options of getting treated were exhausted, she reviewed her end of life alternatives and believed that she wanted physician-assisted suicide.

Her widower, Matt Vickers, who maintained a blog, mentions that Seales, "would have liked the choice to receive physician-assisted death, to bring about her demise no sooner than the point that she determined she had no quality of life, and before she entered a long, pointless and wasteful period of suffering prior to her death". 📣 Express Explained is now on Telegram

In March 2015, Seales and her lawyers filed a statement of claim with the High Court of New Zealand arguing that her general physician should not be prosecuted for assisting her in her death and that under the Bill of Rights Act of 1962, she had the right to not be subjected to "the unnecessary suffering of a long, cruel death."

Seales died on June 5, 2015 and on the same day the judgment of Seales versus Attorney General was made public, in which she was not allowed to seek physician-assisted dying. However, the judge made several statements in support of Seales's wishes and the case became a catalyst in bringing politicians in the country to engage with this topic.
What is assisted dying?
As per the Act, assisted dying means when a person's doctor or nurse gives them medication to relieve their suffering by bringing on death or when a person takes the medication themselves. Therefore, the act interprets assisted dying as referring to both euthanasia and assisted suicide. While the former refers to the act of deliberately ending a person's life to end their suffering, the latter refers to assisting a person to kill themselves.

In some countries such as in the UK, both euthanasia and assisted suicide are illegal. In the UK, while euthanasia is regarded as manslaughter or murder, assisted suicide is punishable by up to 14 years in prison. However, trying to kill yourself is not an illegal act in the country.

As per New Zealand's act, the provisions of the law are limited to terminally ill people and are subject to the fulfillment of various criteria.
What is the eligibility criteria for assisted dying?
In order to be eligible for assisted dying, the individual must be 18 years or older, be a citizen or permanent resident of New Zealand, suffer from a terminal illness that is likely to end their life in less than six months, have a significant and ongoing decline in physical capability, experience unbearable suffering that cannot be eased and they should be able to make an informed decision about assisted dying. The individual should meet all of the criteria to be eligible.
How is a person's competence to make an informed decision measured?
The individual should understand information about assisted dying, remember information about assisted dying in order to make the decision, use or weigh up information about assisted dying to inform their decision and communicate their decision about assisted dying in some way.
Also in Explained | New Zealand's election results, and the enduring popularity of Jacinda Ardern What is not allowed under this law?
A person is not eligible for assisted dying if they are suffering from a mental disorder or a mental illness, if they have a disability of any kind or they are of advanced age. Even so, a health practitioner is now allowed to suggest that a person consider dying while providing a health service to that individual.
What are the methods of assisted dying?
There are four as per the Act. These include ingestion, intravenous delivery, ingestion through a tube or injection. At the chosen time of receiving the medication, the person can either say no or delay the process.
Where else is assisted dying legal?
Assisted dying is legal in parts of Australia, Canada, Colombia, Belgium, Luxembourg, The Netherlands, Switzerland and some states in the US.
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Explained: What is New Zealand's euthanasia or assisted dying act?

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The opponents of the Act such as the Euthanasia Free-NZ group maintain that it lacks oversight and safeguards and have pointed out issues with the eligibility criteria such as the age limit of 18 years and the "arbitrary" nature of the 6-month prognosis.

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Assisted dying and euthanasia will be legal in New Zealand next year, with the public voting through the End of Life Choice Act.

The Electoral Commission released the preliminary results of the End of Life Choice Act referendum on Friday afternoon.

A 50 per cent majority was needed for the law to come into force - allowing terminally ill adults with fewer than six months to live to request assisted dying.

The preliminary figures show 65.2 per cent voted in favour of the act as opposed to 33.8 per cent who voted to maintain the status quo.

READ MORE:
* Euthanasia referendum: Has the End of Life Choice Act passed? We may know today
* Euthanasia and cannabis referendums: Why do we have to wait weeks for the results?
* Euthanasia referendum: Lecretia Seales' widower 'at peace' after five-year fight

One per cent - 25,073 - of the votes were "informal", or invalid votes.

More than 2.4 million New Zealanders voted in the referendum - of those, 1.57 million voted yes.

The End of Life Choice Act will come into effect in November 2021, allowing for safeguards and processes outlined in the Act to be established.

From next year, people who meet the criteria will have the option of legally asking for medical assistance to end their lives.

The End of Life Choice Act referendum was historic - the first time legislation around assisted dying has been put to public vote in New Zealand.

However, it is not the first time Parliament has attempted to legislate assisted dying or euthanasia in New Zealand, with three failed attempts since 1995.

This act, led by ACT Party leader David Seymour, was entered into a ballot in 2015 and upon being drawn, passed three parliamentary readings to get to this stage.

Yes for Compassion executive director Dr Jessica Young said it was "delighted New Zealand came together and voted for choice for their loved ones and for themselves".

Young said New Zealand was admired worldwide as a liberal democracy, and for being the first to give women the vote.

"Today's historic victory continues that tradition, providing the choice of an assisted death to terminally ill Kiwis who want and need it - saving a great deal of unnecessary suffering for individuals and their loved ones."

Young also said she wanted to remember and acknowledge the decades of work that paved the way for the End of Life Choice Act becoming law, including by campaigners who have not lived to see this day.

Stuart Armstrong, who has terminal cancer, was among those supporting the outcome at Parliament on Friday afternoon.

The 60-year-old had flown to Wellington from Lincoln, outside of Christchurch, to mark the occasion, and intended on having a "big knees up" to celebrate.

"It is such a fantastic day," he told Stuff.

"Kiwis had a chance to have their say, and have said it in resounding fashion."

Armstrong, who has campaigned for the act and stated he one day wants to die in a matter he sees fit, said he was "incredibly grateful" for those who had worked to get this result.

"I am very, very proud."

The ACT Party said it was confident it was a "resounding victory" - one that would make New Zealand "a more compassionate and humane society".

"Thousands of New Zealanders who might have suffered excruciating deaths will have choice, dignity, control, and autonomy over their own bodies, protected by the rule of law," Seymour said in a statement.

Meanwhile, conservative lobby group Family First has called the result a "sad and dangerous day for the vulnerable".

"It is one thing to say yes to a nice-sounding phrase around having 'choice', but assisted suicide is not a simple yes no answer," national director Bob McCoskrie said.

He was concerned some New Zealanders may come to feel euthanasia would be the "right thing to do".

The Salvation Army has also expressed "serious concern" over the result.

Mark Campbell, territory commander for the Salvation Army in New Zealand, said it believed many New Zealanders are "unaware of the lack of safeguards contained within the End of Life Choice Act".

He said vulnerable people, such as the elderly and those struggling with mental illness, would be "especially at risk from this law".

The Royal New Zealand College of GPs released a statement saying it was "cautious" about the outcome, which would see some doctors assisting a patient to end their life in 12 months' time.

College president Dr Samantha Murton said while the results gave clear guidance about what options people want at the end of their lives, it "doesn't make it any less complex for medical professionals".

She highlighted rural communities in particular, where some doctors are the only medical care for some distance.

"Our membership is diverse and will run the gamut on personal opinions about euthanasia. However, professionally we are steadfast; we will work within the law and continue to do what is best for our patients."

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Referendum results: End of Life Choice Act passes, legalising assisted dying

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Assisted dying and euthanasia will be legal in New Zealand next year, with the public voting through the End of Life Choice Act. The Electoral Commission released the preliminary results of the End of Life Choice Act referendum on Friday afternoon.

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The preliminary results of New Zealand's referendum on the End of Life Choice Act were conclusive. Some 65.2% of voters supported the law coming into force, while 33.8% opposed it.

Although around 480,000 special votes are still to be counted, the margin is so great there is no chance these will alter the final outcome. Consequently, the End of Life Choice Act 2019 will come into force on November 6 2021, one year after the official vote is announced next week.

It will then become lawful to offer assisted dying (AD) to terminally ill individuals who meet the legislation's eligibility criteria. The delay in the law taking effect provides a 12-month window to implement the necessary arrangements for AD to take place.

One significant issue yet to be determined is whether AD services will be specifically funded, and if so how. The Ministry of Health will need to resolve this over the next year.

In the meantime, what needs to happen next? Immediate priorities for the Director-General of Health under the legislation are:

to appoint a Registrar (assisted dying)

to establish the Support and Consultation for End of Life in New Zealand (SCENZ) Group

to appoint an End of Life Review Committee.

The role of the Registrar (assisted dying)

The Registrar (assisted dying) plays a core role in monitoring and reporting on compliance with the Act. They will also direct any complaints about AD to the appropriate bodies.

The Act, administered by the Ministry of Health, requires adherence to strict regulatory processes. These must be documented in prescribed forms submitted to the Registrar before AD may be performed.

Approving and issuing these prescribed forms falls to the Director-General of Health.

Read more: As NZ votes on euthanasia bill, here is a historical perspective on a 'good death'

What SCENZ will do

Curiously, the Act does not prescribe the composition of the SCENZ Group. It simply requires that the Director-General appoint members with the necessary knowledge and understanding to perform its functions.

The group essentially has two roles:

The second role is largely administrative and facilitative. SCENZ is required to curate and maintain a list of health practitioners willing to be involved in AD, which includes:

doctors willing to act as replacement medical practitioners should a person's own doctor be unwilling to participate in AD due to conscientious objection

medical practitioners willing to provide an independent second opinion on a person's eligibility for AD

psychiatrists willing to provide specialist opinions on a person's capacity, should either or both the attending or independent medical practitioners not be satisfied that the person requesting AD is competent

pharmacists willing to dispense the necessary drugs.

Given these functions, the SCENZ group will presumably be comprised of suitably qualified medical practitioners and pharmacists as well as individuals with knowledge of the relevant law and tikanga Māori, although its final composition remains to be seen.

Read more: Assisted dying referendum: people at the end of their lives say it offers a 'good death'

Compliance and review

The Director-General of Health must also appoint a three-person End of Life Review Committee. This body is tasked with evaluating reports of assisted deaths to determine if the statutory requirements are being complied with. It can refer cases to the Registrar if it is not satisfied.

The Act requires the committee to be comprised of one ethicist and two health practitioners, one of whom must be practising end-of-life care.

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Role of the Medical Council

Given the medical profession will have primary responsibility for providing AD, it's likely its professional body, the Medical Council of New Zealand, will need to begin formulating and consulting on clinical practice standards for medical practitioners involved in providing or facilitating AD.

While the council publishes generic standards of professional practice, including standards for obtaining informed consent and cultural safety, specific guidance should be developed for AD.

The standards should incorporate the legal obligations imposed on medical practitioners under the Act. These include the prohibition on initiating a discussion of AD with a patient, and the legal obligation to inform a patient of their right to a replacement medical practitioner if their doctor objects to AD.

Read more: In places where it's legal, how many people are ending their lives using euthanasia?

The Medical Council could also provide guidance on clinical practice issues that may arise, including ways of identifying coercion, or how to manage difficult conversations with patients (such as when they are found to be ineligible under the Act).

Objection and obligation

Significantly, the Act doesn't require health institutions to provide AD services. Hospice New Zealand has already signalled it will not provide AD, as it is contrary to its philosophy "neither to hasten nor to postpone death".

However, a recent High Court decision notes that although institutions may choose not to provide AD, medical practitioners will still be required to discharge their obligations under the Act - including the obligation to provide information to patients.

Although an organisation may elect not to provide AD, it may employ medical practitioners who are willing to. Provisions will need to be made to enable such practitioners to provide AD outside their own organisation. This is an area that will require careful navigation.

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Assisted dying will become legal in New Zealand in a year - what has to happen now?

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The preliminary results of New Zealand's referendum on the End of Life Choice Act were conclusive. Some 65.2% of voters supported the law coming into force, while 33.8% opposed it. Although around 480,000 special votes are still to be counted, the margin is so great there is no chance these will alter the final outcome.

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New Zealand Supports The Right To Die, But Rejects The Right To Get High

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New Zealanders have voted to allow assisted dying for the terminally ill, but voted down legalizing marijuana. The questions were put to the country in separate referendums held on October 17 th in conjunction with the general election that elected Prime Minister Jacinda Ardern for another term.

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This October, New Zealanders will have to make a life changing decision when they vote in the referendum on the End of Life Choice Act at the general election.

It is important to be clear, your vote is not about the concept of euthanasia.

Your vote is on this Act specifically. Is this the best possible legislation to keep people safe?

No matter the outcome of the referendum it is important to know hospice will continue to support people regardless of their desire for euthanasia.

Our key concerns on the End of Life Act

There is a lack of adequate safeguards in the Act - there is no stand down period from the request to administration of the lethal drug. The only delay between request and death is the 48 hours required for the registrar to check the paperwork. In Oregon, the cooling off period is 15 days, 9 days in Victoria and 10 days in Canada. There are 68 safeguards in the legislation in Victoria, Australia - and within 3 months of the law being passed in 2018, people were pushing for changes.

Determining how long someone has to live is often inaccurate - predicting a life expectancy of 6 months is difficult and often people live longer than expected. A study of doctors' prognoses (the medical prediction of the course of a disease over time) for terminally Ill patients found that only 20% of predictions were accurate - that is, 80% of the time medical prognoses are inaccurate.

The process does not ensure family, friends or whānau are aware of the request. For Māori and Pasifika, collective group decision making is expected. Under this Act, a person's loved ones may not be aware of a request for euthanasia. There is no opportunity to address the underlying factors which motivate the request - such as unresolved physical or emotional pain, fear of being a burden, depression or isolation.

Several long-term conditions that cause disability are also terminal illnesses. People living with a disability caused by multiple sclerosis and motor neurone disease, for example will meet the criteria, as these chronic conditions are incurable.

Detecting coercion and the real reason for a request - detecting what goes on behind closed doors is incredibly complex. There is no test to determine if someone is making a request of their own free will. Coercion can be very subtle and may not even be ill intended, e.g. when patients see the stress of family members who are trying very hard to care for them, this often leads to the feeling of being a burden.

A 2018 analysis into the reasons/end of life concerns that prompted people to request and undertake physician assisted dying in Oregon tells us that, of the 168 people who died,

95% were concerned with a loss in autonomy and the loss of being able to engage in activities that made life enjoyable.

79.4% indicated concerns around loss of dignity,

63% were concerned about being a burden.

Only 31% were concerned with inadequate pain control.

There is no such thing as a slippery slope, it is a natural progression that occurs to many laws, the expansion of criteria over time. Belgium initiated euthanasia law for a small group of people in 2002 - now, euthanasia deaths increase in Belgium by 27% every year. The largest increase in euthanasia cases is among people that are not expected to die in the near future. When the law was first enacted, euthanasia was only available for people 18 or older. In 2014, Belgium extended euthanasia to children as well. Based on the experience of overseas jurisdictions, there is real concern that the criteria in the EOLC Act could very quickly be challenged at a Human Rights level. How long will it take before someone with a disability or dementia or someone under 18 feels discriminated against and takes a case to the Human Rights Court to allow them to access euthanasia?

You can download a printable/shareable info sheet here: Hospice NZ key concerns End of Life Act

Read about the High Court Case taken by Hospice NZ here.

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This October, New Zealanders will have to make a life changing decision when they vote in the referendum on the End of Life Choice Act at the general election. It is important to be clear, your vote is not about the concept of euthanasia. Your vote is on this Act specifically.

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New Zealand has voted to legalise euthanasia

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New Zealand has voted to legalise euthanasia

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Campaigners have called "a victory for compassion and kindness".

Preliminary results showed 65.2% of voters supported the End of Life Choice Act coming into force as a new law.

The law will allow terminally ill people with less than six months to live the opportunity to choose assisted dying if approved by two doctors.

Its opponents say the law lacks adequate safeguards.

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MOHAMAD AMMAR BIN MOHAMAD JAMEL
2018200742

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SHARIFAH NUR SYAMIMI AL-IDRUS BINTI SYED ROSLAN
2018226632

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MUHAMMAD HADWAN BIN ABD GHANI
2018200848

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RAIDA IMAN BINTI AHMAD AZAM
2018200984

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Euthanasia and China: The Traditional Chinese Moral Perspective and Its Social Justice Implications

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Euthanasia and China: The Traditional Chinese Moral Perspective and Its Social Justice Implications

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This article begins by examining the Chinese relatively liberal stance on suicide. It explains the cultural forces that shaped traditional China’s interpretation of life, death and motifs that validate self-sacrifice. To elucidate the Chinese perspective, the article incorporates extensive comparison with Christian viewpoints.

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The discussion on euthanasia in China was sparked off by the first court case of Xia Suwen in1986. This 59-year old female was taken to Han-zhong hospital (Shanxi province) for infectious dis-eases, because she suffered from as cites, cirrhosis of the liver. When it became clear that she was not to recover, her son Wang Mingcheng asked doctor Pu for relief. They were subsequently sued by Xia’s other children, and the case took five years before the final judgement was made of ‘not guilty’ justified by the argument that dose of ‘wintermin’ applied had not been lethal.

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Euthanasia is an emotionally charged issue for people on both sides of the debate. Proponents of euthanasia argue that a person suffering from terminal illness should be given the freedom to choose how and when they die. Such discourse is given weight by the Japanese term for the practice - anrakushi, which literally means "peaceful death."

On the other hand, opponents generally argue that euthanasia is nothing short of murder, and the use of palliative care can often give a terminally ill person a more comfortable, dignified death. In some cases, they say, a desire to die prematurely is merely rooted in depression.

The government has enacted no specific legislation on euthanasia and the Supreme Court has only ruled on the matter once without providing any specific guidance. Instead, the basic framework of Japan's euthanasia policy to date has been laid out in two local court cases, one in Nagoya in 1962, and another after an incident at Tokai University in 1995. The judgments in these cases established a legal framework and a set of conditions within which euthanasia could be legal. In both cases, however, the defendants were found guilty of violating these conditions when hastening the deaths of their patients.

And yet there is still an unwillingness to discuss euthanasia openly, something a group of bipartisan lawmakers wishes to change by submitting a bill on death with dignity, or songenshi, to the Diet this spring. The draft would exempt doctors from criminal and civil responsibility for halting life-prolonging treatment if a patient is over 15 years old and has given consent in writing. Two doctors also need to agree the patient has absolutely no chance of recovering.

Comprising more than 140 lawmakers from across the political spectrum, the bipartisan group has been discussing the issue for almost 10 years. Prime Minister Shinzo Abe has even lent the group his support, saying in a budget meeting last year that legislation on dying with dignity deserved consideration.

With support from both sides of the political divide, it would seem unlikely the bill will be defeated in the Diet. What's more, even opponents of the proposed bill agree that lawmakers should respect a person's right to die as they wish.

But the gulf between the two sides of the debate couldn't be any wider.

Masatoshi Oda was diagnosed with progressive muscular dystrophy as a child, and became a firm believer in dying with dignity as his condition deteriorated. He didn't like the idea of being hooked up to a ventilator, and said that if he ever found himself in such a situation, he would prefer to accept death and leave this world in peace.

Oda didn't want to live if he had to depend on someone being with him around the clock for the rest of his life. He was not suicidal, but rather didn't wish to burden his family with his failing health. Once hooked up to a ventilator, Oda would need assistance to do even the most menial tasks.

In 1997, Oda's lungs collapsed and he went into respiratory failure. He was just 29 years old.

Doctors told Oda's family that he would die unless oxygen was artificially pumped into his body. Despite being aware of Oda's wishes, his mother instructed the hospital to do everything it could to save her son.

"When I regained consciousness, the first thing I saw was a huge machine sitting beside my bed," Oda recalls. He very quickly realized that he had been hooked up to the one thing he feared the most. "I wasn't angry or anything," he says. "It just took a while for me to accept that I had been hooked up to a ventilator."

Had a law on dying with dignity existed back in 1997, Oda would have died. Now, however, the 45-year-old is relieved the doctors performed the tracheotomy and kept him alive.

Had such legislation existed, he would never have had a chance to enjoy a glass of red wine and prosciutto after a day's hard work, nor would he have been able to watch some of his favorite Hollywood movies in theaters. He is now proud to rank "The Avengers" among his favorite films.

Most importantly, however, he would not have been able to be at his mother's side when she passed away a few years later.

"Back in 1997, doctors told me after performing the tracheotomy that I might never speak again," Oda recalls. "But here I am speaking to you now. They also said I might have trouble eating solid food, but three months after the operation I was secretly eating instant noodles in hospital."

Oda heads Co-net, a group of about 60 people who rely on ventilators. While acknowledging that life on a ventilator is certainly not a walk in the park, Oda now realizes he misunderstood what it would be like.

And although he does have to rely on people to complete many daily tasks, he feels that his life is as good as it was before the operation.

For example, even if he misses the last train home after belting out too many Godaigo tunes at karaoke, it isn't the end of the world. He simply goes into a 24-hour manga cafe and asks for permission to recharge the batteries on his ventilator until the train services restart the following morning.

As far as he's concerned, life is worth living.

"I am not against anyone who wishes to die with dignity, but codifying such rights in legislation isn't the answer," he says.

Creating legislation on euthanasia may help clarify the overall process but death shouldn't be turned into a process, let alone a simple one, he says.

"I am living proof that there shouldn't be a law on dying with dignity," he says.

The Japan Society for Dying with Dignity has approximately 125,000 registered members across the country. All members carry identification cards that say they refuse to receive any life-saving treatments once they enter the terminal phase of their illness.

In April last year, the group released a survey of relatives of terminally ill people who passed away in 2012. The survey asked family members whether doctors had in fact agreed to respect the patients' will in terms of their desired medical treatment.

Of the 845 replies the organization received, 696 said they were able to present a Japan Society for Dying with Dignity membership card or convey their sick relatives' wishes concerning treatment to the doctor. Of those, 639 said the doctors agreed to follow the patients' requests.

A total of 18 people, or 3 percent, however, said that doctors chose to act on their own accord and place the dying patient on life support.

Some of those cases involved family members who found themselves unable to go through with their sick relative's wishes. A few cases involved families who were divided over whether or not to pull the plug. Other cases saw doctors giving terminally ill patients the best treatment possible, despite requests to the contrary by disbelieving relatives.

Japan Society for Dying with Dignity President Soichiro Iwao believes that legislation should be in place to govern such situations, otherwise further ad hoc results will occur. "Everyone should have the right to decide how they want to end their life," Iwao says.

Iwao has tried to explain his views to opponents of dying with dignity "but it always feels like our discussion is taking place on different wavelengths."

If anything, setting the rules straight will help doctors do their jobs without fearing subsequent prosecution.

In 2006, a doctor at Imizu City Hospital in Toyama Prefecture was investigated for murder after the hospital revealed that he had disconnected ventilators from seven patients and caused their deaths over a five-year period of time.

The doctor claimed he had obtained consent from the families of all terminally ill patients, but some suggested that appropriate procedures were not followed. The doctor wasn't charged with murder, but the case drew attention to the gray area that exists between medical malpractice and the act of following a dying patient's last wishes.

The courts have adopted a different approach on active euthanasia, viewing such actions as akin to mercy killing rather than the act of letting a patient die without treatment.

In 2009, the Supreme Court upheld an 18-month suspended prison term to a former doctor at a hospital in Kawasaki who injected a muscle relaxant into a terminally ill patient in a bid to hasten their death. The family of the victim claimed they neither requested nor consented to such treatment. The doctor vehemently denied any intent to commit murder, and later published a book titled "Watashi ga Shitakoto ha Satsujin Desuka?" ("Was it Murder that I Committed?") in 2010. In handing down their ruling, the judges failed to create any additional guidelines covering situations in which euthanasia may be recognized.

All the while, the government has sidestepped making any determinations on the subject. In 2007, the Ministry of Health, Labor and Welfare issued a guideline on medical treatment of the terminally ill, but did not lay out clear rules on how or when a doctor can avoid being held legally responsible for respecting a patient's wish to die.

The controversy surrounding the issue is not only limited to Japan. India and Mexico have passed legislation that recognizes passive euthanasia, while Belgium, Luxembourg and the Netherlands have gone so far as to recognize active euthanasia. What's more, Belgium became the first country in the world to abolish all age restrictions on the right to die in a parliamentary vote on Thursday, extending the right to die to terminally ill children.

Nevertheless, the practice still generates plenty of robust opposition. Just last month, for example, a Fort Worth hospital in Texas that kept a woman who was 23 weeks pregnant on life support for two months complied with a court order and removed her from the machines. Doctors had initially refused to honor the family's request to disconnect her, claiming that the law prevented them from doing so until they could perform a cesarean delivery.

Iwao, who also serves as a board member of the World Federation of Right to Die Societies, says there needs to be standard guidelines codified in law to eliminate the confusion in Japan. There is no excuse for failing to establish better guidelines, he says, stressing that the law should ultimately back an individual's right to decide how they want to end their life.

Back when Iwao was the chief of the health ministry's health policy bureau, he didn't see the need to codify guidelines on dying with dignity in legislation. His views changed, however, after he read some surveys on dying with dignity as he was preparing to give a speech at a conference on the issue.

"There was a survey that said more than 80 percent of people wish to spend the last days of their lives at home" instead of on a hospital bed, he says. In reality, however, this seldom happens in Japan. Instead, he says, terminally ill patients are kept alive with ventilators and gastronomy surgeries.

"People who choose that path have every right to do so, but those who do not wish to do so should have an equally respected right to die with dignity," he says. "Despite our rapidly aging society, we've avoided discussing the topic of how to end one's life. The creation of a law gives all of us an opportunity to discuss a subject that is difficult but necessary."

Thirteen years ago, Co-net member Hiromi Ebihara put a ventilator tube in her mouth for the first time and slowly inhaled. She could feel the oxygen rush into her lungs as her heart pumped oxygen-infused red blood cells through her body to her fingertips. In a few seconds, her mind became clear. "I was back to being myself again," Ebihara says, recalling those first few moments on a ventilator.

Ebihara was diagnosed with spinal muscular atrophy as an infant, and over the next two decades her muscles had weakened to the point that they couldn't support her own body weight. She could only inhale about 10 percent of oxygen that a normal adult is able to because her rib cage had suppressed her lungs.

She was put on a ventilator.

Doctors initially said Ebihara wouldn't live beyond her third birthday. Although these days she relies on a wheelchair and ventilator, she has defied common medical knowledge and is now 36 years old.

Co-net members often refer to such cases when highlighting flaws in the proposed legislation, saying doctors often can't tell when a patient becomes terminally ill.

Ebihara, like Oda, is not opposed to terminally ill patients making a decision to end their life. However, she is against the creation of a law that "would make death a decision that is reached after consultation with a flow chart."

"Creating a law would also put more pressure on vulnerable people," she says, noting that it is already tough for seriously ill patients to fight for their lives even though they often have little chance of survival. Any decision to give up in a battle for life should be respected, but laws shouldn't control this process, she says.

"There just needs to be trust, understanding and plenty of communication between the family, doctors and yourself," Ebihara says. "There is no need for a law about dying with dignity."

On Jan. 26, Ebihara took a state exam to become a certified social worker, having spent the past two years studying for the test. If her calculations are correct, she believes she scored well above the passing grade. The results arrive in mid-March.

"I think I passed," she says, looking forward to what the future holds.

Having experienced more medical lows than highs in her lifetime, Ebihara has her own take on death.

"At the end of the day, I don't think there is any dignity in dying," she says. "Rather, it is about living with dignity and, if you can do that, one will likely find themselves right where they want to be at the end."

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Euthanasia is an emotionally charged issue for people on both sides of the debate. Proponents of euthanasia argue that a person suffering from terminal illness should be given the freedom to choose how and when they die. Such discourse is given weight by the Japanese term for the practice - anrakushi, which literally means "peaceful death."

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Japan is torn between believing that euthanasia is giving a person who is terminally ill, a freedom to choose when and how they die which is called anrakushi or peaceful death And some argued that this practice should be considered an act of murder.  Some also said that a person who consents to die prematurely is rooted in depression (Hongo, 2014). But under Japanese law neither euthanasia nor the legalities of withholding treatment that would otherwise prolong a person’s life are clearly defined.

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A vehicle carrying Naoki Yamamoto, one of the suspects in the death of an ALS patient, enters the Kyoto Prefectural Police's Nakagyo Station in Kyoto's Nakagyo Ward on July 23, 2020. (Mainichi/Ai Kawahira)

On July 23, two doctors were arrested on suspicion of administering a lethal drug dose to a woman with amyotrophic lateral sclerosis (ALS), but this is not the first case of this kind in Japan. The incident and those like it demand we ask questions about euthanasia and murder. How should we approach the support and health care provided to patients with intractable illnesses, confronted with solitude and fear?

Euthanasia and dignified deaths at the hands of physicians become a topic of debate every time there is a criminal incident connected to the topic. "Euthanasia" is often considered the killing of a patient through drugs or other means, while "dignified death" is the withholding of life-prolonging measures in the terminal phase of a patient's life. Neither, however, have a clear definition in Japan, legal or otherwise.

Still, in an incident that took place in 1991 at Tokai University Hospital in the city of Isehara, Kanagawa Prefecture, south of Tokyo, in which a doctor killed a terminal cancer patient with a drug injection, the doctor was handed a suspended guilty sentence for murder. At the Yokohama District Court trial, the sentence indicated that for a killing to be recognized as euthanasia, it must meet the following four criteria: the patient is suffering unbearable physical pain; the patient cannot avoid death, which is quickly approaching; there are no alternative methods of eliminating physical pain; and the patient has clearly indicated authorization to shorten their life.

In 1998, there was an incident at Kawasaki Kyodo Hospital in the city of Kawasaki, also in Kanagawa Prefecture, in which a doctor administered a lethal dose of muscle relaxant to an unconscious patient. Between 2000 and 2005, two physicians at Imizu Municipal Hospital in the central Japan city of Imizu, Toyama Prefecture, removed the artificial respirators of seven terminally ill patients. The doctors involved in the cases at Imizu Municipal Hospital were not indicted, and they said that the patients, along with their families and the doctors, had made the decisions together.

The four criteria laid out by the 1991 Yokohama District Court decision in the Tokai University Hospital incident, however, are no longer practical due to advances in medicine that allow for palliative care that can alleviate pain. With the aging of the general population and progress made in medical technology, end-of-life medical care and how one chooses to live their final days have become a big issue. For example, in the case of a patient with terminal cancer who does not have much time left, they may decide not to seek life-prolonging measures considering factors such as the pain it may cause them and the burden that caring for them may impose on family members.

A nonpartisan parliamentary group came up with a bill on dying with dignity in 2012. In 2018, the ruling Liberal Democratic Party (LDP) tried to use that bill as a foundation on which to build a new law with an emphasis on procedures to confirm the intentions of the patient. But the move has concerned disabled people's groups and others that life-prolonging measures would be withheld against the patient's will, and because of that, a new bill has yet to emerge.

On the ground in healthcare and nursing care, there has been a move toward "advance care planning" (ACP), which requires the patient, their family and their primary physicians to hold numerous discussions and decide whether life-prolonging measures will be taken, and to put that down in writing. In 2018, the Ministry of Health, Labor and Welfare amended its guidelines on end-of-life medical care for the first time in 11 years, and adopted the kind of thinking that ACP follows.

Unlike cases in the past, the most recent incident is particularly unusual in that the patient was not in the final stages of ALS, and did not personally know the two physicians that administered the drug that killed her. Yasuhiko Miura, a clinical ethics expert at the Jikei University Kashiwa Hospital, said, "In Japan, even when a patient requests it, 'proactive euthanasia,' in which a physician's actions triggers a patient's death, is not permitted. Compared to past cases, (the latest one) is odd, like the relationship between the patient and the doctors. This may very well have a negative effect on the move to spread ACP."

(Japanese original by Go Kumagai, Lifestyle and Medical News Department)

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Euthanasia or murder for hire? How should Japan confront this question? - The Mainichi

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On July 23, two doctors were arrested on suspicion of administering a lethal drug dose to a woman with amyotrophic lateral sclerosis (ALS), but this is not the first case of this kind in Japan. The incident and those like it demand we ask questions about euthanasia and murder.

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In Japan, doctors' arrests spark calls for euthanasia debate

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Yuri Hayashi, 51, had motor neurone disease and had repeatedly expressed her wish to die. But under Japanese law, euthanasia is complicated.

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The "yes" verdict had been anticipated after polls suggested strong public support for the law, which was also backed by Prime Minister Jacinda Ardern and the opposition leader, Judith Collins.

But it was the result of an emotional, years-long campaign with strong views on both sides of the debate.

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The End of Life Choice Act was passed by parliament in 2019 after years of heated parliamentary debate and a record number of public submissions.

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While there is widespread support for euthanasia reform, there has also been vocal opposition.

As MPs voted on the bill last year, protesters had carried placards stating "assist us to live not die" and "euthanasia is not the solution" outside parliament.

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As she ages, housewife Lee Hyeon Seon, 60, is becoming more afraid of contracting some form of cancer - the number one killer in South Korea. If that happens and she becomes seriously ill, she hopes that her children will respect her wish to reject artificial life-prolonging treatment in hospital and allow her to spend her final days at home.

This way of dying with dignity, also called "well-dying" in South Korea, has been the subject of a national debate for nearly two decades, since two doctors were convicted of assisted murder and given suspended prison terms in 1997 for pulling the plug on a brain-damaged patient at the request of his wife.

Come 2018, Ms Lee will be able to indicate how she wants her life to end, when a well-dying Bill comes into effect.

The law, which allows incurably ill patients to opt out of life-prolonging treatment, was passed by the National Assembly on Jan 8, paving the way for the development of palliative and hospice care services that are lacking in the country.

This is similar to the Advance Medical Directive Act passed in Singapore in 1996. Taiwan adopted similar legislation in 2000.

Right to reject 4 kinds of treatment

South Korea's "well-dying" Bill, passed on Jan 8, will allow terminally ill patients to forgo artificial life-prolonging treatment in the last phase of their life.

But it applies only to patients who have entered the dying process - not upon diagnosis - and have no chance of recovery. These patients will be allowed to refuse four kinds of procedures: cardiopulmonary resuscitation, mechanical ventilation, kidney dialysis and cancer treatment.

To do so, patients must sign an Advance Medical Directive, a document indicating they do not wish to be hooked to life support machines when they are gravely ill.

Another option is to obtain a Doctor's Order. Two doctors must sign the order and consent must also be given by the patient's family.

The law will go into effect only in 2018. This is to allow time for the authorities to work out the details and boost medical facilities like hospices and palliative care centres, which are needed to cope with an expected surge in demand.

First proposed in 2013, the Bill was stuck at the National Assembly for three years before it was passed.
Chang May Choon

In South Korea, critics and religious groups have criticised the Bill, saying it can be deemed as disrespect for life and goes against Confucian values of filial piety.

There are also concerns over the potential for abuse if doctors allow patients and their family members to choose death over treatment.

But the law has drawn support from elderly folk. A survey last year showed that nine in 10 Koreans aged 65 and older did not want to receive treatment to extend their lives if they knew they were suffering from an incurable disease.

"I don't want to prolong the pain and suffering," said Ms Lee. "It's my own life. I want to make my own decision how it should end."

As she does not want to burden her two daughters, who are in their 30s, she said she intends to hire a caregiver to look after her during her last days.

Faced with a rapidly ageing population - 37 per cent by 2050 - and a high suicide rate among the elderly, the South Korean authorities have been trying to promote the concept of well-dying in recent years to encourage elderly folk to open up about a topic once deemed taboo.

Interest in courses that show seniors how to prepare for death has grown over the years. Some even stage their own mock funerals, lying in a coffin-like box to experience the end of life.

The shift in attitudes can be attributed to a 2009 landmark ruling by the Supreme Court for a hospital in Seoul to respect a family's request to remove life support for a comatose woman aged 76. The judge said that to continue treatment when there is no chance of survival can "tarnish one's dignity".

Since then, major hospitals have started allowing terminally ill patients or their family to decline life support. Various civic organisations have also sprung up in favour of well-dying and research centres set up to study the subject.

Professor Choi Joon Sik, an expert on Korean studies who also studies death, said: "The concept of death to Koreans is becoming more practical. It is even okay to mention 'well-dying' in TV programmes, which was taboo several years ago."

Prof Choi said the Bill should have been passed earlier, to help relieve the suffering and financial burden of futile medical treatments on patients.

But he warned that there is a need to address a shortage of hospices within two years, before the law comes into effect.

About 50,000 people die of terminal illnesses every year, according to official statistics. But there are only about 1,000 hospices in the country, which can cater mainly to about 14 per cent of gravely ill cancer patients.

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New law enables South Koreans to 'die well'

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As she ages, housewife Lee Hyeon Seon, 60, is becoming more afraid of contracting some form of cancer - the number one killer in South Korea. If that happens and she becomes seriously ill, she hopes that her children will respect her wish to reject artificial life-prolonging treatment in hospital and allow her to spend her final days at home..

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Two South Koreans were confirmed to have died via voluntary euthanasia in Switzerland.

According to a nonprofit organization called Dignitas, the procedures took place at its facility near Zurich in 2016 and 2018.

The organization assists people in taking their own lives by injecting drugs.

Exit and Dignitas are considered the biggest groups in Switzerland that offer euthanasia services, but only Dignitas accepts foreign nationals.

As of the end of 2018, a total of 32 Koreans had joined the organization. Most of its foreign members are from Germany, but there are also 25 Japanese, 43 Chinese, 36 people from Hong Kong, 18 Singaporeans, 24 Taiwanese and 20 Thais.

Euthanasia is illegal in Korea, where the government implemented end-of-life legislation in February 2018 to help people die with dignity. According to the Ministry of Health and Welfare, about 36,000 people have signed papers requesting that they be allowed to die rather than be subjected to life-prolonging medical treatment in the event that they become terminally ill.

By Park Ju-young (jupark@heraldcorp.com)

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Two Koreans undergo euthanasia in Switzerland

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Two South Koreans were confirmed to have died via voluntary euthanasia in Switzerland.According to a nonprofit organization called Dignitas, the procedures took place at its facility near Zurich in 2016 and 2018.The organization assists people in taking their own lives by injecting drugs.

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South Korea's end-of-life program that enables individuals to abandon life-prolonging medical treatment when there is no chance of recovery went into effect Sunday, following the government's three-month pilot program that began in October, during which 107 terminally ill patients signed the agreement.

According to the program, individuals aged over 19 can submit a written form of their intention to exercise the right to die in the future, if diagnosed by two doctors as terminally ill. The agreement does not mean terminally ill patients will not be provided palliative care to improve life quality until death. The patients instead halt life-sustaining treatment, including CPR, hemodialysis and the use of respirators or anti-cancer drugs, if under severe medical conditions.

Unlike voluntary euthanasia that remains strictly prohibited, end-of-life care does not involve assisted dying measures to help a patient end his or her life.

During the pilot program, 9,336 individuals submitted the form against the use of artificial life-prolonging treatments, according to the Ministry of Welfare, which is in charge of the program. That number is expected to rise, the ministry said.

In South Korea, a highly Confucian society where embracing death is deemed as disrespect for life, the idea of seriously ill people choosing to forgo artificial life-prolonging methods has been uncomfortable for many.

But a rapidly aging population has prompted a shift in the attitude, raising demand for end-of-life care among the elderly.

By Bak Se-hwan ( sh@heraldcorp.com)

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South Korea's end-of-life program that enables individuals to abandon life-prolonging medical treatment when there is no chance of recovery went into effect Sunday, following the government's three-month pilot program that began in October, during which 107 terminally ill patients signed the agreement.

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Slightly over 77 percent of 928 surveyed doctors answered they favor passive euthanasia, with comparable numbers coming to 60 percent of 1,001 cancer patients and 55.3 percent of 1,006 family members.

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Over 60 pct of S. Koreans back 'passive euthanasia': poll | Yonhap News Agency

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Slightly over 77 percent of 928 surveyed doctors answered they favor passive euthanasia, with comparable numbers coming to 60 percent of 1,001 cancer patients and 55.3 percent of 1,006 family members.

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Seoul, South Korea - The Yonsei Severance Hospital in Seoul has removed the artificial respirator that kept alive a woman of 77 years, known as Kim, who has been in a comatose state since February 2008 following a haemorrhage caused by unsuccessful lung surgery. It is the first case of "mercy killing" in South Korea. Doctors carried out the ruling passed last May 21 by the Supreme Court, following a long legal battle between relatives of the woman and the clinic.

At 10:24 this morning (local time) Professor Park Moo-seok removed the power supply and the artificial respirator that kept the patient alive, the woman (in the photo published by the South Korean Yonhap News) has been transferred from 'intensive care unit in a department of general medicine and is being assisted by close relatives. After the declaration of death, which will take place in a matter of hours, Kim will be subjected to an autopsy. Family members have also initiated a civil case against the hospital which performed the operation.

The first case of "passive euthanasia" in South Korea is the result of a dispute lasting over a year. The ruling, made by the judge's, states that Kim has "entered into an irrevocable state" from which "recovery" is "impossible". It adds that "death is imminent without the help of a respirator" and that an extension of the therapy could "harm the dignity of the patient" and be contrary "to her will."

The case has aroused strong controversy across the country. The Catholic Church has Come out in defence of life, stressing that the Court's decision is a sign of the degradation of human life "which is regarded as an object." Lee Hoi-chang, a 74 year-old Korean Catholic politician, spoke of "ambiguities" in the judges decision, saying that "the condition of terminally ill patients does not mean death" and "dying with dignity" means only "putting an end to human life" or, in other words," euthanasia".

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Seoul, South Korea - The Yonsei Severance Hospital in Seoul has removed the artificial respirator that kept alive a woman of 77 years, known as Kim, who has been in a comatose state since February 2008 following a haemorrhage caused by unsuccessful lung surgery. It is the first case of "mercy killing" in South Korea.

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Summary of findings

1. Malaysia just launched its first National Palliative Care Policy and Strategic Planning (2019-2030) after years of research since the early 90s.
2. The palliative care policy is initiated as it is to ensure Malaysians can receive proper care needed in comfort and dignity when facing a life-limiting disease.
3. The policy can contribute to a benefit to a whole community and not selective people.

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Malaysia's Ministry of Health, along with nationwide palliative care providers, launched its first National Palliative Care Policy and Strategic Plan (2019-2030) on the 6th of November at Hospital Selayang in Kuala Lumpur.

It is estimated that over 100,000 Malaysians who die each year require palliative care and by the year 2030, that figure is projected to rise to 230,000.

At present there are only 21 trained palliative care specialists in Malaysia and five specialised palliative care units. Training programmes have been developed to generate more skilled human resources, including doctors, nurses and other allied health professionals.

The National Palliative Care Policy was developed because the Malaysian government, as well as experts in the field of palliative care, agreed that more needs to be done to ensure that all Malaysians will receive the proper care that is needed to ensure comfort and dignity whenever they face a life-limiting illness.

Embarking on a policy to develop nationwide palliative care services will require a large amount of resources and will require collaboration between the government and other stakeholders, including universities, medical schools, civil society groups, NGO hospices, private healthcare services, corporate bodies and the general Malaysian public.

"I believe that everything in this policy can be made into a reality if we all work together and realise how every single person can contribute and make a difference to care and share in the simple things that can mean so much to those in need," said Dr Richard Lim, the national advisor for palliative medicine in the ministry of health.

Home-based care or community palliative care is a vital component of palliative care services in the country. Over the past 28 years, these services have been provided for mainly by charitable non-governmental organisations (NGOs).

At present there are only 30 such NGOs, including Hospis Malaysia and members of the Malaysian Hospice Council, which provide home care services completely free of charge. These services, however, are very limited and only cover larger urban areas.

Funding is lacking for further expansion and the government is therefore looking at ways to collaborate further and enhance these services. Since 2016, the Ministry of Health has started a domiciliary palliative care programme that is now available in a number of states, including: Selangor, Perak, Kedah and Pulau Pinang. Part of the policy's strategic plan is to further develop domiciliary palliative care services to encompass the entire country over the next five years.

"Palliative care is something that will involve all of us at some point in our lives. Whether it is for ourselves or for someone we love dearly, we will all face a time where sickness or old-age will inevitably force us to face our mortality and when that time comes, we must have a system in place that serves as a safety net to ensure that everyone will be supported, comforted and cared for properly till the very end," said Dr Lim.

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Malaysia launches first national policy on palliative care

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Malaysia's Ministry of Health, along with nationwide palliative care providers, launched its first National Palliative Care Policy and Strategic Plan (2019-2030) on the 6th of November at Hospital Selayang in Kuala Lumpur. It is estimated that over 100,000 Malaysians who die each year require palliative care and by the year 2030, that figure is projected to rise to 230,000.

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Summary of findings

1. A lot of factors need to be seen before euthanasia can even be conducted, and sometimes it is not the patient's fault to feel like a burden.
2. Palliative care is still undeveloped and underfunded as it is still in construction.
3. Depression sometimes are the reason why pain management by patients are low, the lack of understanding that pain resolves in mental and social dimensions and not just physiological symptoms.
4. Lack of professionals on the field to cater these patients who are in dire need of treatment.
5. There is no certain cure to some disease which can affect mental conditions of the patient.

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KUALA LUMPUR, Dec 12 - A patient with stage four pancreatic cancer is suffering chronic pain. The tumour has reached his lungs.

For the past four months, he has been bed-ridden. The doctor had told him upon diagnosis he only had half a year to live.

With the pain unbearable, he asks for a lethal prescription to end his life.

Such a scenario is not as uncommon as we would like to believe.

But until today, the global medical community remains divided about assisted suicide. The reasons are, understandably, myriad; the issue involves ethical, legal and moral questions.

To Hospis Malaysia, a non-governmental organisation that specialises in caring for the chronically sick or terminally ill, assisted suicide encapsulates an oversimplified outlook towards an extremely complex issue.

For Hospis Malaysia chief executive officer Dr Ednin Hamzah, any attempt at an informed discourse on assisted suicide or euthanasia cannot take place without first discussing the preconditions that drive these patients to want to die:

Have doctors or hospitals done enough to alleviate their pain?

"Reasons (justified) for assisted suicide are usually these three," Dr Ednin explained in an interview with Malay Mail recently.

"First is unbearable suffering, it might be physical suffering like pain; second, loss of meaning, I am terminally ill so I have no worth and no value of life anymore; third, I am sick, I can't do anything, I am a burden to others."

"But why don't we look at our pain management?"
Rubbish pain management?
If anything, palliative care experts like Dr Ednin feel the debate on whether the chronic or terminally ill should have the right to decide the manner of their deaths casts a spotlight on how the country cares for its sickest population.

Malaysia's palliative care sector, according to him, is still underdeveloped and underfunded, with public hospitals still lacking experts specifically trained to care for patients with or without advanced medical conditions, while most Malaysians cannot afford those in private institutions.

And ensuring public hospitals have adequate and affordable care professionals who specialise in treating and managing pain is crucial to the debate on assisted suicide.

Dr Ednin said palliative care experts ensure dying patients in pain suffer as little as possible, and by doing so, disincentivises them from viewing suicide as a painless solution to their condition.

"In Malaysia, our pain management is rubbish," he asserted.

"The indicator or benchmark of cancer pain management is the use of morphine. If you look at the International Narcotics Control Board (INCB) data, Malaysia ranks somewhere down there in terms of our use of morphine."

The INCB ranking placed Malaysia among the highest countries with a chronic morphine abuse problem resulting from overuse in pain treatment, said the Hospis Malaysia CEO.

"For medication with cancer, our pain management is not good enough. But do we even bring up that issue? I've never seen that raised in the media."

In a 2015 report published as a guideline for the use of opioids in treating chronic pain, the Malaysian Association for the Study of Pain noted the worrying increase in the use of drugs like morphine to treat patients with non-chronic cancer pain, leading to misuse and addiction.

Dr Ednin suggests this increased use of morphine underscores the problem with public healthcare's "mechanical" approach to pain - by treating a condition with complex and layered components only with substances that target the physiological symptoms of pain, but exclude others.

Pain also has mental and social dimensions, the Hospis Malaysia CEO explained. In the case of terminally ill patients, their condition often induces depression and in many cases has been found to influence patients' thoughts on suicide.

But most "healthcare settings" lack clinical psychologists who can diagnose and treat depression among the chronically sick or terminally ill, said Dr Ednin.
Lacking clinical psychologists
And without a trained psychologist to make the right prognosis, ascertaining if their request for assisted suicide was done rationally would be impossible, an argument long held by opponents of euthanasia or physician-aided dying.

Combine this with a rigidly physiological approach to disease and pain treatment, there is a risk that doctors or patients could be misguided into making ill-informed decisions.

"What about the psychological needs of our patients?

"That's exactly the problem. The treatment of patients is very physical, not psychological. We don't look at the psychological, spiritual and emotional aspects of illnesses," Dr Ednin said.

Diseases such as cancer also cause a significant burden to the patient and their family.

It affects their finances, makes illness a central part of the lives of everyone involved and turns families into caregivers; thus, affecting the normal function of a family.

And this problem can put a strain on relationships. Dealing with such a condition would require specific training involving medical and social skills, which Dr Ednin said can be provided by professional social-medical workers.

Yet, most of the country's public hospitals are still found wanting of these trained specialists, the Hospis Malaysia CEO argued.

"Patients sometimes want to be independent so they don't want to be a burden to their family, and thereby, you have this situation (where they think of terminating their own lives)," he said.

"(But) for most families, they don't mind because it is their duty to look after their family member so this is mostly a perception issue.

"Sometimes, it might be a practical issue but it can be sorted out through discussions and a reframing of what can or can't be done by different people."

However, the Ministry of Health (MoH) in a response to Malay Mail said the government has been developing palliative care services since the mid 1990s.

The first dedicated in-patient palliative care unit was a pilot project at the Queen Elizabeth Hospital in Kota Kinabalu, Sabah, in 1995, which according to the ministry's director-general Datuk Dr Noor Hisham Abdullah provided the impetus for further development of palliative care services in other government hospitals.

"In 1998, MoH decided to have a more structured palliative care service and this has led to the development of many palliative care services in the MoH hospitals," he said.

At present, there are 11 trained palliative medicine specialists in the MoH with 14 of its hospitals offering specialised palliative care services, seven with resident specialists and the rest integrated through a cluster hospital initiative, said Dr Noor Hisham.

"Apart from this, there are 11 MoH hospitals with dedicated palliative care teams providing basic palliative care services," he added.

Dr Noor Hisham said the MoH has also initiated the movement of palliative care services from hospitals to community palliative care services in 2016, where a domiciliary palliative care programme was developed to provide home care to patients in rural areas not covered by non-governmental hospice groups.
No silver bullet
Just recently, MoH launched the National Palliative Care Policy and Strategic Plan 2019-2030 to help develop a national palliative care agenda, a 10-year blueprint aimed at making palliative care a core discipline of public healthcare.

Dr Ednin is cautious not to be overly optimistic.

He feels there is still much to be done in terms of upskilling and training of healthcare workers to deliver the care, and changing mindsets with regards to understanding that a palliative care referral "is not-an-instead of curative treatment, but can complement whatever medical treatment and therapy the patient is undergoing."

As the government's plan to decriminalise suicide bids has sparked debate about assisted suicide, the Hospis Malaysia CEO feels there is a need to ramp up public awareness about palliative care.

At the moment, the number of patients who have requested aided dying remains small, just a "handful" from some 2,000 patients that Hospis Malaysia is treating or has treated yearly, which reflects the success of appropriate pain treatment and care, said Dr Ednin.

But is palliative care the silver bullet to treating chronic pain? Not necessarily.

The Hospis Malaysia CEO said there are still conditions where it may be arguably justified that patients be given the power to decide their own deaths, but not until all options have been fully exhausted.

"All this can be dealt with. It may not address the needs of everyone, but it will deal with the majority of people who may request euthanasia or assisted suicide," he said.

"So do we keep the debate (about assisted suicide) open? We can."

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Time to discuss right to die? Maybe we should talk about palliative care (or its lack of) in Malaysia first | Malay Mail

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KUALA LUMPUR, Dec 12 - A patient with stage four pancreatic cancer is suffering chronic pain. The tumour has reached his lungs. For the past four months, he has been bed-ridden. The doctor had told him upon diagnosis he only had half a year to live. With the pain unbearable, he asks for a...

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Korea will allow terminally ill patients to choose death with dignity by discontinuing life-supporting treatment.

The Ministry of Health and Welfare said it will allow passive euthanasia for terminally ill patients on a trial basis starting from next week before fully implementing it by February next year.

Life-support treatments include cardiopulmonary resuscitation, respirators, hemodialysis and cancer treatments.

Only terminally ill patients with no chance of recovery can opt to refuse life-support. Such patients must also show no positive responses to medication, or experience a rapid deterioration in health leading to imminent death.

Those seeking to die with dignity must have their prognosis confirmed by their primary physician and one other doctor.

If a patient is comatose, two of his or her family members will make decisions on continuing life-support treatments.

Copyright © Chosunilbo & Chosun.com

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Korea to Temporarily Allow Terminally Ill Patients to Choose Death with Dignity

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Korea will allow terminally ill patients to choose death with dignity by discontinuing life-supporting treatment. The Ministry of Health and Welfare said it will allow passive euthanasia for terminally ill patients on a trial basis starting from next week before fully implementing it by February next year.

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They agreed that doctors could stop prolonged life-sustaining treatment, based only on prior written or oral statements from patients.

But they failed to agree on mercy killing for mentally disabled and other patients who cannot express their wish, the ministry said in a statement.

Ministry officials said the guidelines would be used to enact a new law on euthanasia, although no timetable has been set for when parliament would debate the legislation.

A 77-year-old brain-dead woman died in January, 202 days after being taken off life support in the country's first case of legal euthanasia.

The woman was declared brain-dead in February 2008 after she fell into a coma while undergoing a lung examination. Three months later her children filed a court petition after doctors rejected their request to remove the life support system.

Her children said that artificially prolonging her life when she was brain-dead was "painful and meaningless".

A court approved the family's request but doctors appealed. The Supreme Court upheld the lower court's decision in favour of the children in May last year.

The case fuelled debate in a country where some still oppose mercy killing because of deep-rooted Confucianist beliefs. In 2007 a father was given a four-year suspended jail term for removing a respirator from his brain-dead son.

Source: AFP

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Euthanasia Legal for the Terminally Ill In S.Korea Now

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They agreed that doctors could stop prolonged life-sustaining treatment, based only on prior written or oral statements from patients. But they failed to agree on mercy killing for mentally disabled and other patients who cannot express their wish, the ministry said in a statement.

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Euthanasia  been the subject of a national debate for nearly two decades, since two doctors were convicted of assisted murder and given suspended prison terms in 1997 for pulling the plug on a brain-damaged patient at the request of his wife.

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Why China Should Start Planning for Legal Euthanasia

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Why China Should Start Planning for Legal Euthanasia

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Fu Ta-jen wore many hats over the course of his long and storied career, from basketball player and championship-winning coach to decorated television show host and color commentator. But perhaps his most important role was also his last: euthanasia advocate.

Tall, athletic, and well-built, the Taiwan-based Fu was a true physical specimen. But after his pancreatic cancer diagnosis in 2016, he quickly dropped weight, eventually reaching just 108 pounds. Given months to live, he became an active proponent of legalizing euthanasia, and, on June 7, 2018, he underwent the procedure in Switzerland. He was the first Taiwan resident to be legally euthanized there, and his decision made waves both in Taiwan and on the Chinese mainland.

Euthanasia is illegal in China and in most of the world. But in a country where an estimated 255 million people - almost 18 percent of the population - will be at or above 60 by 2020, end-of-life care is a critical, if still largely taboo topic. Just last week, Gu Jin, the chief physician at Peking University Cancer Hospital and a delegate to China's "two sessions" legislative meetings, proposed implementing a nationwide "death education" curriculum for students of all ages. Netizens ran with the idea, suggesting the country "open the door" to euthanasia as well. While such a change is many years away - if it happens at all - that doesn't mean we shouldn't start thinking about what it would mean for patients and how best to prepare for it.

The first known case of illegal euthanasia involving a doctor took place in China in 1986, in the northwestern province of Shaanxi. That year, Wang Mingcheng and his youngest sister took their mother, Xia Suwen, to a local infectious disease hospital for treatment. Xia, who was in extreme pain due to complications from cirrhosis, repeatedly cried out that she wanted to die, according to later reports.

Upon reviewing Xia's case, her doctor, Pu Liansheng, informed her children that there was nothing he could do. Saying they could not bear to watch their mother suffer, Wang and his sister asked him to end her misery. He refused at first, but after repeated entreaties, Pu prescribed 100 milligrams of a compound of chlorpromazine and promethazine, which was later doubled. 20 hours later, Xia passed away.

Those involved were eventually investigated and arrested. But a few years later, a judge ruled that, while Wang Mingcheng had intentionally deprived his mother of life, "[his] act was notably minimal, the harm was not serious, and it did not constitute a crime." The doctor, Pu, was acquitted for similar reasons.

Since then, there have been few reports of euthanasia involving doctors in Chinese media. That doesn't mean there's no demand for it, however. Rather, the burden appears to have fallen on family members and friends instead. In mid-2017, a man ran over his friend's wife twice with his car. An investigation into the incident showed she had late-stage cancer and, together with her husband, had repeatedly asked for the man's help in ending her life. Also in 2017, a woman with an autoimmune disease asked her family to help her kill herself. Her son-in-law bought her rat poison, and the next day she drank it while he and her daughter watched.

These cases have proven extremely difficult to adjudicate. On the one hand, the courts recognize that in most instances, the assisting party was under significant physical and mental stress. Euthanasia is a last resort and is often carried out only at the patient's request. In light of this, further court-administered punishment can seem cruel, only extending the family's tragedy.

On the other hand, some legal experts worry that if the sentences are too light, it will send a signal that such acts are socially or ethically acceptable. Nevertheless, in these cases Chinese judges tend to weigh extenuating circumstances more heavily than they might otherwise, absolving those involved from responsibility, even in cases where guilt is clear.

Outside the courtroom, societal attitudes toward euthanasia may be changing. In March 2017, the famous Taiwan-based romance novelist Chen Che, better known by her pen name, Chiung Yao, published an open letter to her children on Facebook. In it, the now-80-year-old openly declared that, no matter what happens in the future, she did not want to be intubated, made to undergo major surgery, or sent to an intensive care unit. "To help me die without pain [would be] an act of far greater meaning than doing everything you can think of to keep me alive," she wrote.

Chen's letter aroused a spirited debate on the Chinese mainland, where her works are popular. Even the party-run media outlet People's Daily weighed in, publishing a commentary that included the line, "A good death is life's highest wish, and also its most basic right."

But we must recognize that the legalization of euthanasia cannot be rushed. At present, almost all the countries that allow euthanasia - including the Netherlands, Belgium, Switzerland, and Canada - also possess highly developed economies and strong welfare systems.

China's own medical system is not up to those standards. Many Chinese - scholars and members of the public alike - worry that if euthanasia is legalized in our country, patients will feel pressured to undergo the procedure for financial reasons, such as an inability to afford their medical bills.

Access to adequate palliative care is another important precursor to legalizing euthanasia. In some cases, if patients had better access to palliative treatment - and they and their families were provided with good psychological counseling and spiritual support - then perhaps they wouldn't be so willing to opt for euthanasia.

Work must also be done to raise awareness of euthanasia among the Chinese public and explain how it would fit in with the country's traditional family ethics, which stress filial piety and caring for one's parents. In particular, the media and authorities should make it clear that euthanasia is a choice for some, rather than the only choice for all patients, and stress that no one should ever be pressured into undergoing the procedure. As a bioethicist interested in the ethics of euthanasia, I know just how much work - both conceptual and empirical - is still to be done on this subject in China.

None of this is to say we can't take steps to address terminally ill patients' concerns in the present, however. Once again, we should look to Taiwan for guidance. Although euthanasia is not legal there, a law went into effect earlier this year allowing patients who were sound of mind to prepare a legally binding document forbidding clinicians from providing "meaningless" life-saving treatment like CPR, defibrillation, or intubation in the event of an irreversible coma, permanent vegetative state, severe dementia, or similar issues.

The Chinese mainland lacks comparable legislation. The closest we have is the nonprofit Beijing Living Will Promotion Association, which was established in 2013 and encourages people to make living wills. It's a good exercise, and the documents can help raise awareness of end-of-life issues, but they're not legally binding.

Earlier this year, Fu Ta-jen's family released a video of his final moments. Surrounded by his loved ones, Fu takes a drink and, after a while, falls into his son's arms. The scene was solemn, yet warm. It's never easy to say goodbye, but that doesn't mean we can't help those in need do so with dignity.
Translator: Matt Turner; editors: Zhang Bo and Kilian O'Donnell. (Header image: Fu Ta-jen talks about euthasia during a "living memorial service" held in his honor in Taiwan, Dec. 28, 2016. IC)

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Why China Should Start Planning for Legal Euthanasia

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Fu Ta-jen wore many hats over the course of his long and storied career, from basketball player and championship-winning coach to decorated television show host and color commentator. But perhaps his most important role was also his last: euthanasia advocate. Tall, athletic, and well-built, the Taiwan-based Fu was a true physical specimen.

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Chinese concepts of euthanasia and health care

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Chinese concepts of euthanasia and health care

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- Reasons for the historical assisted suicide court cases.
- Ethics of Euthanasia principles.

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Chinese concepts of euthanasia and health care

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Lawful status: Illegal (yet still complicated because of a few recorded cases regarding patients asking to kill themselves due to desperate situations)
Pro-argument:  the courts admit that in most cases, the assisting side was under serious physical and mental stress. Therefore, the court considered lighter punishments to not extend the family's tragedy.
Counter-argument:  Some legal experts worry that if the sentences are too light, it will send a signal that such acts are socially or ethically acceptable.

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The National People's Congress (in simplified Chinese 全国人民代表大会), abbreviated NPC, is the highest organ of state power. The Standing Committee of the NPC is the permanent organ of the NPC. The term of office of the NPC and its Standing Committee is five years. The NPC gathers each year at the first quarter and is called by its Standing Committee. Since 1954, the People's Republic of China has convened 11 National People's Congresses.

References:

1. (Chinese) Previous NPCs. Xinhua. Jan 18, 2013.

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The Communist Party of China Website (cpcchina.org) is the first and only encyclopedia website about the Communist Party of China (CPC). It provides news, opinion, photos, videos, policy statements and historical facts about the CPC and allows readers to interact with the CPC in various ways.

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More in-depth of several popular active euthanasia.

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EUTHANASIA SHOULD BE LEGALIZED IN CHINA PERSONAL PERSPECTIVE

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In October, New Zealand voters approved a referendum proposal to legalize medically assisted suicide, thus joining a small group of countries and territories that allow euthanasia under specific circumstances. The proposal sprang from a lawsuit brought by a lawyer dying from a brain tumor, and while she herself was not seeking to end her life prematurely, she felt frustrated that the option did not exist. In court, she argued that euthanasia was not suicide, which is a crime, because the person in question was going to die anyway of the affliction that made their life difficult. She lost the case and died in 2015, but her husband continued to work on the issue, and, as a result, the topic received attention from the media, which discussed the ramifications, including what kind of safeguards were needed to prevent patients from simply ending their lives due to advanced age or disability.

Such a discussion has yet to emerge in Japan, although a criminal case in Kyoto that came to light in July has highlighted the issue in a sensational way. Two doctors were arrested on suspicion of murder after they helped a woman named Yuri Hayashi with the neurological disease amyotrophic lateral sclerosis (ALS) fulfill her wish to die. One of the doctors, Yoshikazu Okubo, provides hospice care, and apparently read on social media of Hayashi's desire. He somehow contacted her and offered to help. Hayashi ended her life last November, but because of her condition, which made it impossible for her to feed herself or move any part of her body, the physicians' assistance necessarily required more than just providing a lethal dose of drugs.

Media coverage has focused mainly on the criminal aspect. Prior to her death, Hayashi transferred ¥1.3 million to the bank account of Naoki Yamamoto, the second doctor arrested, thus prompting the police to charge both physicians with " murder by contract." Police have released scant information about Yamamoto, although he may have written a how-to book about helping someone die without any signs that it was an assisted suicide. Police insist that Hayashi's death is not a case of euthanasia.

On Nov. 3, the NHK series "Heart Net TV" presented Hayashi's side of the story through her Twitter account and blog, which chronicled her situation for 586 days prior to her death.

NHK was cautious in its presentation. At one point, Hayashi tweeted that she felt "miserable" when she saw herself in a mirror. It's the kind of statement that advocate groups for people with disabilities cite as representing a line of thought that sees people with disabilities as a burden on society, and thus encourages discrimination. However, at another point Hayashi speculates that if euthanasia were legalized, it might extend more lives, since those with terminal conditions could live a more fulfilling life with the knowledge that they could choose to end it if day-to-day existence became too much to bear physically.

NHK mentions Okubo once, but does not detail how the plan to die was realized. The half-hour program is essentially an ongoing argument that Hayashi has with herself about whether ending her life is better than continuing on as she is. She veers widely between despair and moments of contentment, and parties on either side of the euthanasia argument will probably find remarks that support their respective positions.

Associate professor Hitoshi Arima of Yokohama City University, who has published a book about euthanasia, was interviewed in Toyo Keizai last August, in which he addressed the Kyoto incident in order to determine if it was a case of murder or medically assisted suicide undertaken for humanitarian reasons. The biggest problem Arima has with the case is that neither Okubo nor Yamamoto were Hayashi's physician. They were basically outside contractors brought in by the patient to perform a one-off service. Under such circumstances, the doctors did not have as deep an understanding of Hayashi's medical condition and state of mind as that of a primary care physician, who would have been following Hayashi's situation for a long period of time and thus possess insight into her stated desire to die. A service relationship conducted mainly over social media cannot provide such insight.

Arima is opposed to legalizing assisted suicide, but his point about close communication is the foundation of euthanasia policy in countries where it is legal. There are certain steps that a society must take first in order to arrive at an understanding of what assisted dying entails, and Japan has yet to take these steps. The first would be to normalize the practice of living wills and do-not-resuscitate declarations, which express a patient's refusal of extraordinary measures to keep them alive in the case of a medical emergency.

The government has tried to promote this way of thinking through the advanced care planning program, mainly for budgetary reasons. Japan's national insurance system spends a lot of money to keep people alive in a vegetative state simply because doctors are compelled to administer extraordinary measures to keep patients alive regardless of the outcome in terms of quality of life. The advanced care planning program, more familiarly known as jinsei kaigi (life council), promotes family discussions on end-of-life care well before an elderly or terminally ill member would require such care. In 2017, a health ministry survey found that only 2.8% of families had held any such discussion, and only 3.3% were even familiar with the advanced care planning program. Since then these numbers have gone up, but not by much.

The government's subsequent actions to promote the advanced care planning program has been clumsy at best, as evidenced by an embarrassing poster campaign briefly carried out last year. Medically assisted suicide is still a controversial topic, even in those countries where it is legal. But before it can even be discussed in Japan, people have to be willing to talk openly and frankly about their own death.

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A frank conversation is needed on euthanasia

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In October, New Zealand voters approved a referendum proposal to legalize medically assisted suicide, thus joining a small group of countries and territories that allow euthanasia under specific circumstances. The proposal sprang from a lawsuit brought by a lawyer dying from a brain tumor, and while she herself was not seeking to end her life prematurely, she felt frustrated that the option did not exist.

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New Zealand Supports The Right To Die, But Rejects The Right To Get High

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New Zealanders have voted to allow assisted dying for the terminally ill, but voted down legalizing marijuana. The questions were put to the country in separate referendums held on October 17 th in conjunction with the general election that elected Prime Minister Jacinda Ardern for another term.

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Legalization of Euthanasia in South Korea

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Legalization of Euthanasia in South Korea

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Right to reject 4 kinds of treatment

South Korea's "well-dying" Bill, passed on Jan 8, will allow terminally ill patients to forgo artificial life-prolonging treatment in the last phase of their life.

But it applies only to patients who have entered the dying process - not upon diagnosis - and have no chance of recovery. These patients will be allowed to refuse four kinds of procedures: cardiopulmonary resuscitation, mechanical ventilation, kidney dialysis and cancer treatment.

To do so, patients must sign an Advance Medical Directive, a document indicating they do not wish to be hooked to life support machines when they are gravely ill.

Another option is to obtain a Doctor's Order. Two doctors must sign the order and consent must also be given by the patient's family.

The law will go into effect only in 2018. This is to allow time for the authorities to work out the details and boost medical facilities like hospices and palliative care centres, which are needed to cope with an expected surge in demand.

First proposed in 2013, the Bill was stuck at the National Assembly for three years before it was passed.

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What Is Euthanasia? Types, Legal Status, Facts, Controversy, and

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Euthanasia is practice that helps people who are terminally ill or in extreme pain end their lives. We’ll go over the different types of euthanasia, what they involve, and where they’re legal. We’ll also break down some of the controversy surrounding it and give you tips for how to make difficult end-of-life decisions.

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A person should be able to decide when to end and how they will die if they’re terminally ill as it will end the pain and burden, they’re experiencing. However, there should be a set of conditions given before performing euthanasia. Written consent is needed and discussions between family members should also be done too. A group of lawmaker who has been working for almost 10 years to legalize euthanasia has suggested these conditions:

· Patient has to be over 15 years old

· Patient has to give written consent

· Two doctors need to agree that the patient has no chance of surviving/ terminally ill

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Introduction
What is euthanasia for China?
- In China (Chang, Chai, 2015) there are two types of suicide; self-regarding and other-regarding.
Self-regarding- According to the belief of Confucian, it is a petty self-destruction. Ending the life for self-purposes like, avoiding loss of dignity, freeing oneself from an undignified existance.
Other-regarding- To benefit subjects outside the self. Dying for the sake of others. Other than that, the term had been elavated to praise-worthy  (Chang, Chai, 2015).

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What are the key features that makes euthanasia possible?
- Still illegal in China, therefore no conditions to carry out.
- Yet, it is still practiced in some hospitals.
- There are some reported incidents that have been prominent for researches to support the favor of legalizing euthanasia.
For example, the Xia Siwen case.
- In Faulkner's research, "Chinese concept of euthanasia & healthcare", Yixue Lunlixue author of Medical Ethic listed several arguments in support of euthanasia for example, 1) a good death is the patient's right, 2) it befits the good of society, prevents wasting resources on terminally ill patients with no hopes of survival.

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Is euthanasia possible with just mere consent from the patient?
- From what have been researched, no.
- Because of assisted suicide is still illegal, there is no official written conditions into carry out euthanasia however, there has been many recorded cases with repeated patient's condition. 1) Parents' wishes. 2) Terminally ill.
- Moreover, we should also consider their collectivist culture.
- Chang, Chai, 2015, discussed this by using the Confucian belief where euthanasia is not an expression of individuality but also a demonstration of communistic authority.
- This means that the act of assisted suicide involves the community rather than just the participants.

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I think euthanasia should be decriminalized as it would give the patient and their family a second choice of life. However, I hope that if euthanasia is legalized in the future, the people who are eligible of the act do not feel like they have to do it because of society's pressure of not being a good person to lighten the burden of family (or people who are involve in the person's life).